|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
OP
|
$9,731.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.47 |
| Max. Negotiated Rate |
$8,757.90 |
| Rate for Payer: Adventist Health Commercial |
$1,946.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,481.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,909.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,625.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.84
|
| Rate for Payer: Blue Shield of California Commercial |
$5,906.72
|
| Rate for Payer: Blue Shield of California EPN |
$3,863.21
|
| Rate for Payer: Cash Price |
$5,352.05
|
| Rate for Payer: Cash Price |
$5,352.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,784.80
|
| Rate for Payer: Cigna of CA HMO |
$6,227.84
|
| Rate for Payer: Cigna of CA PPO |
$7,200.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$8,271.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,838.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,757.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: InnovAge PACE Commercial |
$3,721.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,490.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,946.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,324.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$7,298.25
|
| Rate for Payer: Networks By Design Commercial |
$6,325.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Prime Health Services Commercial |
$8,271.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,630.06
|
| Rate for Payer: Riverside University Health System MISP |
$2,729.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,838.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,838.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISK ASPIRATION
|
Facility
|
OP
|
$21,320.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,280.71 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$4,264.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,481.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$11,726.00
|
| Rate for Payer: Cash Price |
$11,726.00
|
| Rate for Payer: Cash Price |
$11,726.00
|
| Rate for Payer: Central Health Plan Commercial |
$17,056.00
|
| Rate for Payer: Cigna of CA HMO |
$13,644.80
|
| Rate for Payer: Cigna of CA PPO |
$15,776.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$18,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,188.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,280.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: InnovAge PACE Commercial |
$3,721.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,220.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,324.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$15,990.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$13,858.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$18,122.00
|
| Rate for Payer: Prime Health Services Medicare |
$2,630.06
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,729.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,792.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISK ASPIRATION
|
Facility
|
IP
|
$21,320.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,264.00 |
| Max. Negotiated Rate |
$19,188.00 |
| Rate for Payer: Adventist Health Commercial |
$4,264.00
|
| Rate for Payer: Cash Price |
$11,726.00
|
| Rate for Payer: Central Health Plan Commercial |
$17,056.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,528.00
|
| Rate for Payer: Galaxy Health WC |
$18,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,188.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,220.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,122.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,197.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,264.00
|
| Rate for Payer: Multiplan Commercial |
$15,990.00
|
| Rate for Payer: Networks By Design Commercial |
$13,858.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,122.00
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906820031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.95
|
| 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 |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| Rate for Payer: Cigna of CA HMO |
$401.70
|
| Rate for Payer: Cigna of CA PPO |
$457.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$429.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.80
|
| 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: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$254.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.33
|
| 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 |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$341.25
|
| Rate for Payer: Cigna of CA PPO |
$388.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$429.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| 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: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$388.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO |
$262.50
|
| Rate for Payer: United Healthcare HMO Rider |
$262.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906820031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
|
|
HC DISTRTN NEUROLTC AGT GNCLR NRV
|
Facility
|
OP
|
$6,936.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
909004624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,481.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,358.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,073.51
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,548.80
|
| Rate for Payer: Cigna of CA HMO |
$4,439.04
|
| Rate for Payer: Cigna of CA PPO |
$5,132.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$5,895.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,161.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,242.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$644.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: InnovAge PACE Commercial |
$3,721.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,324.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,508.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$5,895.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,630.06
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,729.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISTRTN NEUROLTC AGT GNCLR NRV
|
Facility
|
IP
|
$6,936.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
909004624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,387.20 |
| Max. Negotiated Rate |
$6,242.40 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,774.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,774.40
|
| Rate for Payer: Galaxy Health WC |
$5,895.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,161.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,242.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,642.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,293.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.20
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
| Rate for Payer: Networks By Design Commercial |
$4,508.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,895.60
|
|
|
HC DLTN URTHRL STRCTR MALE; INITIAL
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
900501600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Central Health Plan Commercial |
$694.40
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$781.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$651.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.00
|
| Rate for Payer: United Healthcare All Other HMO |
$434.00
|
| Rate for Payer: United Healthcare HMO Rider |
$434.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC DLTN URTHRL STRCTR MALE; INITIAL
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
900501600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$781.20 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Central Health Plan Commercial |
$694.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$781.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$651.00
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC DLTR VESSEL 5FR
|
Facility
|
OP
|
$50.84
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$45.76 |
| Rate for Payer: Adventist Health Commercial |
$10.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.86
|
| Rate for Payer: Blue Shield of California Commercial |
$31.06
|
| Rate for Payer: Blue Shield of California EPN |
$20.29
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Central Health Plan Commercial |
$40.67
|
| Rate for Payer: Cigna of CA HMO |
$32.54
|
| Rate for Payer: Cigna of CA PPO |
$37.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.34
|
| Rate for Payer: Galaxy Health WC |
$43.21
|
| Rate for Payer: Global Benefits Group Commercial |
$30.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.76
|
| Rate for Payer: InnovAge PACE Commercial |
$25.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.59
|
| Rate for Payer: Multiplan Commercial |
$38.13
|
| Rate for Payer: Networks By Design Commercial |
$33.05
|
| Rate for Payer: Prime Health Services Commercial |
$43.21
|
| Rate for Payer: Riverside University Health System MISP |
$20.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.42
|
| Rate for Payer: United Healthcare All Other HMO |
$25.42
|
| Rate for Payer: United Healthcare HMO Rider |
$25.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.21
|
| Rate for Payer: Vantage Medical Group Senior |
$43.21
|
|
|
HC DLTR VESSEL 5FR
|
Facility
|
IP
|
$50.84
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$45.76 |
| Rate for Payer: Adventist Health Commercial |
$10.17
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Central Health Plan Commercial |
$40.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.34
|
| Rate for Payer: Galaxy Health WC |
$43.21
|
| Rate for Payer: Global Benefits Group Commercial |
$30.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$38.13
|
| Rate for Payer: Networks By Design Commercial |
$33.05
|
| Rate for Payer: Prime Health Services Commercial |
$43.21
|
|
|
HC DLTR VESSEL 6FR
|
Facility
|
OP
|
$53.63
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$48.27 |
| Rate for Payer: Adventist Health Commercial |
$10.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.50
|
| Rate for Payer: Blue Shield of California Commercial |
$32.77
|
| Rate for Payer: Blue Shield of California EPN |
$21.40
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Central Health Plan Commercial |
$42.90
|
| Rate for Payer: Cigna of CA HMO |
$34.32
|
| Rate for Payer: Cigna of CA PPO |
$39.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.45
|
| Rate for Payer: EPIC Health Plan Senior |
$21.45
|
| Rate for Payer: Galaxy Health WC |
$45.59
|
| Rate for Payer: Global Benefits Group Commercial |
$32.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.27
|
| Rate for Payer: InnovAge PACE Commercial |
$26.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.54
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$34.86
|
| Rate for Payer: Prime Health Services Commercial |
$45.59
|
| Rate for Payer: Riverside University Health System MISP |
$21.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.82
|
| Rate for Payer: United Healthcare All Other HMO |
$26.82
|
| Rate for Payer: United Healthcare HMO Rider |
$26.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.59
|
| Rate for Payer: Vantage Medical Group Senior |
$45.59
|
|
|
HC DLTR VESSEL 6FR
|
Facility
|
IP
|
$53.63
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$48.27 |
| Rate for Payer: Adventist Health Commercial |
$10.73
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Central Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.45
|
| Rate for Payer: EPIC Health Plan Senior |
$21.45
|
| Rate for Payer: Galaxy Health WC |
$45.59
|
| Rate for Payer: Global Benefits Group Commercial |
$32.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$34.86
|
| Rate for Payer: Prime Health Services Commercial |
$45.59
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
IP
|
$77.90
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$70.11 |
| Rate for Payer: Adventist Health Commercial |
$15.58
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Central Health Plan Commercial |
$62.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Senior |
$31.16
|
| Rate for Payer: Galaxy Health WC |
$66.22
|
| Rate for Payer: Global Benefits Group Commercial |
$46.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$58.42
|
| Rate for Payer: Networks By Design Commercial |
$50.63
|
| Rate for Payer: Prime Health Services Commercial |
$66.22
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
OP
|
$77.90
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$70.11 |
| Rate for Payer: Adventist Health Commercial |
$15.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.75
|
| Rate for Payer: Blue Shield of California Commercial |
$47.60
|
| Rate for Payer: Blue Shield of California EPN |
$31.08
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Central Health Plan Commercial |
$62.32
|
| Rate for Payer: Cigna of CA HMO |
$49.86
|
| Rate for Payer: Cigna of CA PPO |
$57.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Senior |
$31.16
|
| Rate for Payer: Galaxy Health WC |
$66.22
|
| Rate for Payer: Global Benefits Group Commercial |
$46.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.11
|
| Rate for Payer: InnovAge PACE Commercial |
$38.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.53
|
| Rate for Payer: Multiplan Commercial |
$58.42
|
| Rate for Payer: Networks By Design Commercial |
$50.63
|
| Rate for Payer: Prime Health Services Commercial |
$66.22
|
| Rate for Payer: Riverside University Health System MISP |
$31.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.95
|
| Rate for Payer: United Healthcare All Other HMO |
$38.95
|
| Rate for Payer: United Healthcare HMO Rider |
$38.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.22
|
| Rate for Payer: Vantage Medical Group Senior |
$66.22
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
915365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,785.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,008.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,381.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.40
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
905365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,355.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,080.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,310.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,363.75
|
| Rate for Payer: Blue Shield of California EPN |
$890.57
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,897.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,897.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,008.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,116.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,381.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,562.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,562.40
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Riverside University Health System MISP |
$892.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,339.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
915365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,355.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,080.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,310.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,363.75
|
| Rate for Payer: Blue Shield of California EPN |
$890.57
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,897.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,897.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,008.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,116.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,381.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,562.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,562.40
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Riverside University Health System MISP |
$892.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,339.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
905365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,785.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,008.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,381.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.40
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.29
|
| Rate for Payer: Blue Shield of California Commercial |
$21.85
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.55
|
| Rate for Payer: EPIC Health Plan Senior |
$13.74
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: InnovAge PACE Commercial |
$20.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.74
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$14.56
|
| Rate for Payer: Riverside University Health System MISP |
$15.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.13
|
| Rate for Payer: United Healthcare HMO Rider |
$11.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
