|
HC PTB SOCKET FOR AFO ADDITION LE
|
Facility
|
IP
|
$2,064.00
|
|
|
Service Code
|
CPT L2350
|
| Hospital Charge Code |
915352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$1,857.60 |
| Rate for Payer: Adventist Health Commercial |
$412.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,595.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,040.26
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,651.20
|
| Rate for Payer: Cigna of CA HMO |
$1,444.80
|
| Rate for Payer: Cigna of CA PPO |
$1,444.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$825.60
|
| Rate for Payer: EPIC Health Plan Senior |
$825.60
|
| Rate for Payer: Galaxy Health WC |
$1,754.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,238.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,857.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Multiplan Commercial |
$1,548.00
|
| Rate for Payer: Networks By Design Commercial |
$1,341.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,754.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$774.62
|
| Rate for Payer: United Healthcare All Other HMO |
$753.98
|
| Rate for Payer: United Healthcare HMO Rider |
$737.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.96
|
|
|
HC PTB SOCKET FOR AFO ADDITION LE
|
Facility
|
IP
|
$2,064.00
|
|
|
Service Code
|
CPT L2350
|
| Hospital Charge Code |
905352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$1,857.60 |
| Rate for Payer: Adventist Health Commercial |
$412.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,595.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,040.26
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,651.20
|
| Rate for Payer: Cigna of CA HMO |
$1,444.80
|
| Rate for Payer: Cigna of CA PPO |
$1,444.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$825.60
|
| Rate for Payer: EPIC Health Plan Senior |
$825.60
|
| Rate for Payer: Galaxy Health WC |
$1,754.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,238.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,857.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Multiplan Commercial |
$1,548.00
|
| Rate for Payer: Networks By Design Commercial |
$1,341.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,754.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$774.62
|
| Rate for Payer: United Healthcare All Other HMO |
$753.98
|
| Rate for Payer: United Healthcare HMO Rider |
$737.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.96
|
|
|
HC PTB SOCKET FOR AFO ADDITION LE
|
Facility
|
OP
|
$2,064.00
|
|
|
Service Code
|
CPT L2350
|
| Hospital Charge Code |
915352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$675.96 |
| Max. Negotiated Rate |
$1,857.60 |
| Rate for Payer: Adventist Health Commercial |
$846.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,754.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,135.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,548.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,212.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,595.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,040.26
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,651.20
|
| Rate for Payer: Cigna of CA HMO |
$1,444.80
|
| Rate for Payer: Cigna of CA PPO |
$1,444.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,754.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,754.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$825.60
|
| Rate for Payer: EPIC Health Plan Senior |
$825.60
|
| Rate for Payer: Galaxy Health WC |
$1,754.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,238.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,857.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,230.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,032.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,444.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,444.80
|
| Rate for Payer: Multiplan Commercial |
$1,548.00
|
| Rate for Payer: Networks By Design Commercial |
$1,032.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,754.40
|
| Rate for Payer: Riverside University Health System MISP |
$825.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,238.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,238.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$774.62
|
| Rate for Payer: United Healthcare All Other HMO |
$753.98
|
| Rate for Payer: United Healthcare HMO Rider |
$737.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,754.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,754.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,754.40
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,638.40
|
| Rate for Payer: Cigna of CA HMO |
$9,456.20
|
| Rate for Payer: Cigna of CA PPO |
$10,765.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,093.20
|
| Rate for Payer: InnovAge PACE Commercial |
$7,274.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,909.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
| Rate for Payer: Riverside University Health System MISP |
$5,819.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,728.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,728.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,909.60 |
| Max. Negotiated Rate |
$13,093.20 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,638.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,093.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,542.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,909.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$12,366.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$11,129.40 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,248.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,711.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,654.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
OP
|
$12,366.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,801.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,274.50
|
| 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 |
$6,801.30
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Cigna of CA HMO |
$8,037.90
|
| Rate for Payer: Cigna of CA PPO |
$9,150.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,511.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,511.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,248.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,654.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,656.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,656.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,946.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,419.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,511.10
|
|
|
HC PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.57
|
| Rate for Payer: Blue Shield of California Commercial |
$164.97
|
| Rate for Payer: Blue Shield of California EPN |
$107.73
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: InnovAge PACE Commercial |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Riverside University Health System MISP |
$108.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO |
$135.00
|
| Rate for Payer: United Healthcare HMO Rider |
$135.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
|
OP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.60 |
| Max. Negotiated Rate |
$1,748.70 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,179.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,068.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,457.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$940.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,141.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.17
|
| Rate for Payer: Blue Shield of California EPN |
$775.26
|
| Rate for Payer: Cash Price |
$1,068.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,554.40
|
| Rate for Payer: Cigna of CA HMO |
$1,243.52
|
| Rate for Payer: Cigna of CA PPO |
$1,437.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,651.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,651.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.20
|
| Rate for Payer: EPIC Health Plan Senior |
$777.20
|
| Rate for Payer: Galaxy Health WC |
$1,651.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,165.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,748.70
|
| Rate for Payer: InnovAge PACE Commercial |
$971.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,295.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,360.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,360.10
|
| Rate for Payer: Multiplan Commercial |
$1,457.25
|
| Rate for Payer: Networks By Design Commercial |
$1,262.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,651.55
|
| Rate for Payer: Riverside University Health System MISP |
$777.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,165.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,165.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$971.50
|
| Rate for Payer: United Healthcare All Other HMO |
$971.50
|
| Rate for Payer: United Healthcare HMO Rider |
$971.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$971.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,651.55
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
|
IP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.60 |
| Max. Negotiated Rate |
$1,748.70 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Cash Price |
$1,068.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.20
|
| Rate for Payer: EPIC Health Plan Senior |
$777.20
|
| Rate for Payer: Galaxy Health WC |
$1,651.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,165.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,748.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,295.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.60
|
| Rate for Payer: Multiplan Commercial |
$1,457.25
|
| Rate for Payer: Networks By Design Commercial |
$1,262.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,651.55
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$23,930.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,786.00 |
| Max. Negotiated Rate |
$21,537.00 |
| Rate for Payer: Adventist Health Commercial |
$4,786.00
|
| Rate for Payer: Cash Price |
$13,161.50
|
| Rate for Payer: Central Health Plan Commercial |
$19,144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,572.00
|
| Rate for Payer: Galaxy Health WC |
$20,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,537.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,961.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,117.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,812.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,786.00
|
| Rate for Payer: Multiplan Commercial |
$17,947.50
|
| Rate for Payer: Networks By Design Commercial |
$15,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$20,340.50
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$20,340.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,068.00 |
| Max. Negotiated Rate |
$18,306.00 |
| Rate for Payer: Adventist Health Commercial |
$4,068.00
|
| Rate for Payer: Cash Price |
$11,187.00
|
| Rate for Payer: Central Health Plan Commercial |
$16,272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,136.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,136.00
|
| Rate for Payer: Galaxy Health WC |
$17,289.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,204.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,306.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,566.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,749.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,590.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,068.00
|
| Rate for Payer: Multiplan Commercial |
$15,255.00
|
| Rate for Payer: Networks By Design Commercial |
$13,221.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,289.00
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$23,930.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$748.41 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,786.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$13,161.50
|
| Rate for Payer: Cash Price |
$13,161.50
|
| Rate for Payer: Cash Price |
$13,161.50
|
| Rate for Payer: Central Health Plan Commercial |
$19,144.00
|
| Rate for Payer: Cigna of CA HMO |
$15,554.50
|
| Rate for Payer: Cigna of CA PPO |
$17,708.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$20,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,537.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$748.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,961.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,786.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$17,947.50
|
| Rate for Payer: Networks By Design Commercial |
$15,554.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Prime Health Services Commercial |
$20,340.50
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,358.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$20,340.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$748.41 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,068.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$11,187.00
|
| Rate for Payer: Cash Price |
$11,187.00
|
| Rate for Payer: Cash Price |
$11,187.00
|
| Rate for Payer: Central Health Plan Commercial |
$16,272.00
|
| Rate for Payer: Cigna of CA HMO |
$13,221.00
|
| Rate for Payer: Cigna of CA PPO |
$15,051.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$17,289.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,204.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,306.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$748.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,566.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,068.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$15,255.00
|
| Rate for Payer: Networks By Design Commercial |
$13,221.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Prime Health Services Commercial |
$17,289.00
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,204.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,204.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
OP
|
$1,119.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,007.10 |
| Rate for Payer: Adventist Health Commercial |
$458.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$679.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$951.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$615.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| 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 |
$615.45
|
| Rate for Payer: Cash Price |
$615.45
|
| Rate for Payer: Cash Price |
$615.45
|
| Rate for Payer: Central Health Plan Commercial |
$895.20
|
| Rate for Payer: Cigna of CA HMO |
$716.16
|
| Rate for Payer: Cigna of CA PPO |
$828.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$951.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$951.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$951.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.60
|
| Rate for Payer: EPIC Health Plan Senior |
$447.60
|
| Rate for Payer: Galaxy Health WC |
$951.15
|
| Rate for Payer: Global Benefits Group Commercial |
$671.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,007.10
|
| Rate for Payer: InnovAge PACE Commercial |
$559.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$746.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$783.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$783.30
|
| Rate for Payer: Multiplan Commercial |
$839.25
|
| Rate for Payer: Networks By Design Commercial |
$727.35
|
| Rate for Payer: Prime Health Services Commercial |
$951.15
|
| Rate for Payer: Riverside University Health System MISP |
$447.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$671.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$671.40
|
| 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 |
$951.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$951.15
|
| Rate for Payer: Vantage Medical Group Senior |
$951.15
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
IP
|
$1,119.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$223.80 |
| Max. Negotiated Rate |
$1,007.10 |
| Rate for Payer: Adventist Health Commercial |
$223.80
|
| Rate for Payer: Cash Price |
$615.45
|
| Rate for Payer: Central Health Plan Commercial |
$895.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.60
|
| Rate for Payer: EPIC Health Plan Senior |
$447.60
|
| Rate for Payer: Galaxy Health WC |
$951.15
|
| Rate for Payer: Global Benefits Group Commercial |
$671.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,007.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$746.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.80
|
| Rate for Payer: Multiplan Commercial |
$839.25
|
| Rate for Payer: Networks By Design Commercial |
$727.35
|
| Rate for Payer: Prime Health Services Commercial |
$951.15
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900407163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Central Health Plan Commercial |
$760.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.20
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Adventist Health Commercial |
$389.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$577.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$808.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$713.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| 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 |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Central Health Plan Commercial |
$760.80
|
| Rate for Payer: Cigna of CA HMO |
$608.64
|
| Rate for Payer: Cigna of CA PPO |
$703.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$808.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$808.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.16
|
| Rate for Payer: InnovAge PACE Commercial |
$475.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$665.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$665.70
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
| Rate for Payer: Riverside University Health System MISP |
$380.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.60
|
| 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 |
$808.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.35
|
| Rate for Payer: Vantage Medical Group Senior |
$808.35
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Central Health Plan Commercial |
$760.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.20
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900417163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Adventist Health Commercial |
$389.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$577.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$808.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$713.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| 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 |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Central Health Plan Commercial |
$760.80
|
| Rate for Payer: Cigna of CA HMO |
$608.64
|
| Rate for Payer: Cigna of CA PPO |
$703.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$808.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$808.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.16
|
| Rate for Payer: InnovAge PACE Commercial |
$475.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$665.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$665.70
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
| Rate for Payer: Riverside University Health System MISP |
$380.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.60
|
| 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 |
$808.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.35
|
| Rate for Payer: Vantage Medical Group Senior |
$808.35
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900417163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Central Health Plan Commercial |
$760.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.20
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
905197163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Adventist Health Commercial |
$389.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$577.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$808.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$713.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| 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 |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Central Health Plan Commercial |
$760.80
|
| Rate for Payer: Cigna of CA HMO |
$608.64
|
| Rate for Payer: Cigna of CA PPO |
$703.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$808.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$808.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.16
|
| Rate for Payer: InnovAge PACE Commercial |
$475.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$665.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$665.70
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
| Rate for Payer: Riverside University Health System MISP |
$380.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.60
|
| 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 |
$808.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.35
|
| Rate for Payer: Vantage Medical Group Senior |
$808.35
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
905197163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Central Health Plan Commercial |
$760.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.20
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900407163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Adventist Health Commercial |
$389.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$577.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$808.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$713.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| 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 |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Central Health Plan Commercial |
$760.80
|
| Rate for Payer: Cigna of CA HMO |
$608.64
|
| Rate for Payer: Cigna of CA PPO |
$703.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$808.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$808.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.16
|
| Rate for Payer: InnovAge PACE Commercial |
$475.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$665.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$665.70
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
| Rate for Payer: Riverside University Health System MISP |
$380.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.60
|
| 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 |
$808.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.35
|
| Rate for Payer: Vantage Medical Group Senior |
$808.35
|
|
