|
HC PT APPLICATION HOT/COLD PACKS
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 97010
|
| Hospital Charge Code |
905103104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.65
|
| Rate for Payer: Dignity Health Media |
$143.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$126.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.29
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Riverside University Health System MISP |
$67.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.65
|
| Rate for Payer: Vantage Medical Group Senior |
$143.65
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$902.98 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: Blue Distinction Transplant |
$8,620.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,494.40
|
| Rate for Payer: Cigna of CA PPO |
$10,632.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$12,212.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,620.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,931.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,776.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,679.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: InnovAge PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,873.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$10,776.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$9,339.20
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$12,212.80
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Riverside University Health System MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,620.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$902.98 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: Blue Distinction Transplant |
$8,620.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,494.40
|
| Rate for Payer: Cigna of CA PPO |
$10,632.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$12,212.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,620.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,931.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,776.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,679.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: InnovAge PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,873.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$10,776.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$9,339.20
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$12,212.80
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Riverside University Health System MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,620.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,873.60 |
| Max. Negotiated Rate |
$12,931.20 |
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,747.20
|
| Rate for Payer: Galaxy Health WC |
$12,212.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,620.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,931.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,474.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,873.60
|
| Rate for Payer: Multiplan Commercial |
$10,776.00
|
| Rate for Payer: Networks By Design Commercial |
$9,339.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,212.80
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,873.60 |
| Max. Negotiated Rate |
$12,931.20 |
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,747.20
|
| Rate for Payer: Galaxy Health WC |
$12,212.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,620.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,931.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,474.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,873.60
|
| Rate for Payer: Multiplan Commercial |
$10,776.00
|
| Rate for Payer: Networks By Design Commercial |
$9,339.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,212.80
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.36 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,866.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Dignity Health Media |
$13,702.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,702.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,090.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,642.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Riverside University Health System MISP |
$6,448.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,702.00
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$14,508.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$14,508.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.36 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,866.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Dignity Health Media |
$13,702.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,702.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,090.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,642.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Riverside University Health System MISP |
$6,448.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,702.00
|
|
|
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: Blue Shield of California EPN |
$1,102.18
|
| Rate for Payer: Cash Price |
$928.80
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$412.80
|
| 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: United Healthcare All Other Commercial |
$779.37
|
| Rate for Payer: United Healthcare All Other HMO |
$761.20
|
| Rate for Payer: United Healthcare HMO Rider |
$744.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$681.12
|
|
|
HC PTB SOCKET FOR AFO ADDITION LE
|
Facility
|
OP
|
$2,064.00
|
|
|
Service Code
|
CPT L2350
|
| Hospital Charge Code |
905352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$722.40 |
| Max. Negotiated Rate |
$1,857.60 |
| 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 |
$1,135.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$999.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,219.41
|
| Rate for Payer: Blue Distinction Transplant |
$1,238.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,548.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,122.82
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| 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 Media |
$1,754.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$825.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,548.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$722.40
|
| 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: LLUH Dept of Risk Management WC |
$846.24
|
| 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 |
$1,032.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,032.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,032.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,032.00
|
| 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
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,840.71 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,840.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Media |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,485.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,359.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Riverside University Health System MISP |
$6,125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,782.60 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,840.71 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,840.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Media |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,485.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,359.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Riverside University Health System MISP |
$6,125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,782.60 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
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: 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 |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.52
|
| Rate for Payer: Blue Distinction Transplant |
$162.00
|
| Rate for Payer: Blue Shield of California Commercial |
$169.83
|
| Rate for Payer: Blue Shield of California EPN |
$132.03
|
| Rate for Payer: Cash Price |
$121.50
|
| 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 Media |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$202.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.50
|
| 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: 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
|
| 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 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: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
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: Cash Price |
$874.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 |
$9,246.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,246.25
|
| 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 |
$1,068.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$940.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.92
|
| Rate for Payer: Blue Distinction Transplant |
$1,165.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,222.15
|
| Rate for Payer: Blue Shield of California EPN |
$950.13
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cash Price |
$874.35
|
| 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 Media |
$1,651.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,651.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,457.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$680.05
|
| 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: 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
|
| 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 Medi-Cal |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,651.55
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,037.80 |
| Max. Negotiated Rate |
$22,670.10 |
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Central Health Plan Commercial |
$20,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,075.60
|
| Rate for Payer: Galaxy Health WC |
$21,410.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,670.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,801.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,597.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,037.80
|
| Rate for Payer: Multiplan Commercial |
$18,891.75
|
| Rate for Payer: Networks By Design Commercial |
$16,372.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,410.65
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$826.73 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,987.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,113.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Central Health Plan Commercial |
$20,151.20
|
| Rate for Payer: Cigna of CA PPO |
$18,639.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$21,410.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,670.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,891.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,783.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,801.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$18,891.75
|
| Rate for Payer: Networks By Design Commercial |
$16,372.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,410.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Riverside University Health System MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$826.73 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,987.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,113.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Central Health Plan Commercial |
$20,151.20
|
| Rate for Payer: Cigna of CA PPO |
$18,639.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$21,410.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,670.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,891.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,783.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,801.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$18,891.75
|
| Rate for Payer: Networks By Design Commercial |
$16,372.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,410.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Riverside University Health System MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,037.80 |
| Max. Negotiated Rate |
$22,670.10 |
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Central Health Plan Commercial |
$20,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,075.60
|
| Rate for Payer: Galaxy Health WC |
$21,410.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,670.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,801.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,597.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,037.80
|
| Rate for Payer: Multiplan Commercial |
$18,891.75
|
| Rate for Payer: Networks By Design Commercial |
$16,372.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,410.65
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN OT
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905104212
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Central Health Plan Commercial |
$228.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: Galaxy Health WC |
$243.10
|
| Rate for Payer: Global Benefits Group Commercial |
$171.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$257.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.20
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Networks By Design Commercial |
$185.90
|
| Rate for Payer: Prime Health Services Commercial |
$243.10
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN OT
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905104212
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$173.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$171.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Central Health Plan Commercial |
$228.80
|
| Rate for Payer: Cigna of CA HMO |
$183.04
|
| Rate for Payer: Cigna of CA PPO |
$211.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.10
|
| Rate for Payer: Dignity Health Media |
$243.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$114.40
|
| Rate for Payer: Galaxy Health WC |
$243.10
|
| Rate for Payer: Global Benefits Group Commercial |
$171.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$257.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$214.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.26
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Networks By Design Commercial |
$185.90
|
| Rate for Payer: Prime Health Services Commercial |
$243.10
|
| Rate for Payer: Riverside University Health System MISP |
$114.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Vantage Medical Group Senior |
$243.10
|
|
