|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
905352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.11
|
| Rate for Payer: Blue Shield of California Commercial |
$173.43
|
| Rate for Payer: Blue Shield of California EPN |
$114.21
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
915352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.11
|
| Rate for Payer: Blue Shield of California Commercial |
$173.43
|
| Rate for Payer: Blue Shield of California EPN |
$114.21
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
905352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
915352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
|
OP
|
$22,357.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Cigna of CA HMO |
$14,308.48
|
| Rate for Payer: Cigna of CA PPO |
$16,544.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$19,003.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,414.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$856.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$969.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,365.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$17,885.60
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$14,532.05
|
| Rate for Payer: Prime Health Services Commercial |
$19,003.45
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,414.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
|
IP
|
$22,357.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,471.40 |
| Max. Negotiated Rate |
$19,003.45 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,942.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,942.80
|
| Rate for Payer: Galaxy Health WC |
$19,003.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,414.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,518.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,838.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,365.68
|
| Rate for Payer: Multiplan Commercial |
$17,885.60
|
| Rate for Payer: Networks By Design Commercial |
$14,532.05
|
| Rate for Payer: Prime Health Services Commercial |
$19,003.45
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
IP
|
$25,486.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906811476
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,097.20 |
| Max. Negotiated Rate |
$21,663.10 |
| Rate for Payer: Adventist Health Commercial |
$5,097.20
|
| Rate for Payer: Cash Price |
$11,468.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,194.40
|
| Rate for Payer: Galaxy Health WC |
$21,663.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15,291.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,999.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,710.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,775.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,116.64
|
| Rate for Payer: Multiplan Commercial |
$20,388.80
|
| Rate for Payer: Networks By Design Commercial |
$16,565.90
|
| Rate for Payer: Prime Health Services Commercial |
$21,663.10
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
OP
|
$25,486.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906811476
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,097.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$11,468.70
|
| Rate for Payer: Cash Price |
$11,468.70
|
| Rate for Payer: Cash Price |
$11,468.70
|
| Rate for Payer: Cigna of CA HMO |
$16,311.04
|
| Rate for Payer: Cigna of CA PPO |
$18,859.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$21,663.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15,291.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$719.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,999.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,116.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$20,388.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$16,565.90
|
| Rate for Payer: Prime Health Services Commercial |
$21,663.10
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
IP
|
$37,348.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906820007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,469.60 |
| Max. Negotiated Rate |
$31,745.80 |
| Rate for Payer: Adventist Health Commercial |
$7,469.60
|
| Rate for Payer: Cash Price |
$16,806.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,939.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,939.20
|
| Rate for Payer: Galaxy Health WC |
$31,745.80
|
| Rate for Payer: Global Benefits Group Commercial |
$22,408.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,229.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,118.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,963.52
|
| Rate for Payer: Multiplan Commercial |
$29,878.40
|
| Rate for Payer: Networks By Design Commercial |
$24,276.20
|
| Rate for Payer: Prime Health Services Commercial |
$31,745.80
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
OP
|
$37,348.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906820007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,469.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$16,806.60
|
| Rate for Payer: Cash Price |
$16,806.60
|
| Rate for Payer: Cash Price |
$16,806.60
|
| Rate for Payer: Cigna of CA HMO |
$23,902.72
|
| Rate for Payer: Cigna of CA PPO |
$27,637.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$31,745.80
|
| Rate for Payer: Global Benefits Group Commercial |
$22,408.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$719.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,963.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$29,878.40
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$24,276.20
|
| Rate for Payer: Prime Health Services Commercial |
$31,745.80
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,408.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC VASC EMBOL OCC ART VEN HEM LYM EXTRVST
|
Facility
|
OP
|
$28,171.00
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
906811477
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,634.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$12,676.95
|
| Rate for Payer: Cash Price |
$12,676.95
|
| Rate for Payer: Cash Price |
$12,676.95
|
| Rate for Payer: Cigna of CA HMO |
$18,029.44
|
| Rate for Payer: Cigna of CA PPO |
$20,846.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$23,945.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,902.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,000.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,790.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,131.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,761.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$22,536.80
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$18,311.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,945.35
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,902.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VASC EMBOL OCC ART VEN HEM LYM EXTRVST
|
Facility
|
IP
|
$28,171.00
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
906811477
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,634.20 |
| Max. Negotiated Rate |
$23,945.35 |
| Rate for Payer: Adventist Health Commercial |
$5,634.20
|
| Rate for Payer: Cash Price |
$12,676.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,268.40
|
| Rate for Payer: EPIC Health Plan Senior |
$11,268.40
|
| Rate for Payer: Galaxy Health WC |
$23,945.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,902.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,790.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,733.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,437.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,761.04
|
| Rate for Payer: Multiplan Commercial |
$22,536.80
|
| Rate for Payer: Networks By Design Commercial |
$18,311.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,945.35
|
|
|
HC VASC EMBOL OCC PX W PRESSURE GEN CATH
|
Facility
|
OP
|
$35,541.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
906811600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$7,108.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,825.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$15,993.45
|
| Rate for Payer: Cash Price |
$15,993.45
|
| Rate for Payer: Cash Price |
$15,993.45
|
| Rate for Payer: Cigna of CA HMO |
$22,746.24
|
| Rate for Payer: Cigna of CA PPO |
$26,300.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$30,209.85
|
| Rate for Payer: Global Benefits Group Commercial |
$21,324.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,705.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,529.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$28,432.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$23,101.65
|
| Rate for Payer: Prime Health Services Commercial |
$30,209.85
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,324.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,770.50
|
| Rate for Payer: United Healthcare All Other HMO |
$17,770.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17,770.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,770.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC VASC EMBOL OCC PX W PRESSURE GEN CATH
|
Facility
|
IP
|
$35,541.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
906811600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,108.20 |
| Max. Negotiated Rate |
$30,209.85 |
| Rate for Payer: Adventist Health Commercial |
$7,108.20
|
| Rate for Payer: Cash Price |
$15,993.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14,216.40
|
| Rate for Payer: Galaxy Health WC |
$30,209.85
|
| Rate for Payer: Global Benefits Group Commercial |
$21,324.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,705.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,541.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,999.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,529.84
|
| Rate for Payer: Multiplan Commercial |
$28,432.80
|
| Rate for Payer: Networks By Design Commercial |
$23,101.65
|
| Rate for Payer: Prime Health Services Commercial |
$30,209.85
|
|
|
HC VASC EMBOL OCC VENOUS
|
Facility
|
IP
|
$22,357.00
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
906811475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,471.40 |
| Max. Negotiated Rate |
$19,003.45 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,942.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,942.80
|
| Rate for Payer: Galaxy Health WC |
$19,003.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,414.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,518.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,838.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,365.68
|
| Rate for Payer: Multiplan Commercial |
$17,885.60
|
| Rate for Payer: Networks By Design Commercial |
$14,532.05
|
| Rate for Payer: Prime Health Services Commercial |
$19,003.45
|
|
|
HC VASC EMBOL OCC VENOUS
|
Facility
|
OP
|
$22,357.00
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
906811475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Cigna of CA HMO |
$14,308.48
|
| Rate for Payer: Cigna of CA PPO |
$16,544.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$19,003.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,414.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,361.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,325.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,365.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$17,885.60
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$14,532.05
|
| Rate for Payer: Prime Health Services Commercial |
$19,003.45
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,414.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VASC THROMBIX HEMOSTASIS
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
906812432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.45
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$208.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$171.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$171.50
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.50
|
| Rate for Payer: United Healthcare All Other HMO |
$122.50
|
| Rate for Payer: United Healthcare HMO Rider |
$122.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
|
HC VASC THROMBIX HEMOSTASIS
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
906812432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC VASCULAR SOLUTIONS VASC BAND
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
906812488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.87
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cigna of CA HMO |
$103.04
|
| Rate for Payer: Cigna of CA PPO |
$119.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: EPIC Health Plan Senior |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.70
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.50
|
| Rate for Payer: United Healthcare All Other HMO |
$80.50
|
| Rate for Payer: United Healthcare HMO Rider |
$80.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.85
|
| Rate for Payer: Vantage Medical Group Senior |
$136.85
|
|
|
HC VASCULAR SOLUTIONS VASC BAND
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
906812488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: EPIC Health Plan Senior |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
|
|
HC VASCUTRAK PTA BALLOON
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909021725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,468.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,870.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,232.01
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC VASCUTRAK PTA BALLOON
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909021725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
|
|
HC VASOPNEUMATIC DEVICE MCAL
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901300043
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$114.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: Cigna of CA HMO |
$178.56
|
| Rate for Payer: Cigna of CA PPO |
$206.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$237.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$111.60
|
| Rate for Payer: Galaxy Health WC |
$237.15
|
| Rate for Payer: Global Benefits Group Commercial |
$167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$195.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$195.30
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: Networks By Design Commercial |
$181.35
|
| Rate for Payer: Prime Health Services Commercial |
$237.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$167.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$167.40
|
| 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 |
$237.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.15
|
| Rate for Payer: Vantage Medical Group Senior |
$237.15
|
|
|
HC VASOPNEUMATIC DEVICE MCAL
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901300043
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: Adventist Health Commercial |
$55.80
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$111.60
|
| Rate for Payer: Galaxy Health WC |
$237.15
|
| Rate for Payer: Global Benefits Group Commercial |
$167.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.96
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: Networks By Design Commercial |
$181.35
|
| Rate for Payer: Prime Health Services Commercial |
$237.15
|
|
|
HC VASOPNEUMATIC DEVICE MCARE COMM
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900407041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: Adventist Health Commercial |
$55.80
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$111.60
|
| Rate for Payer: Galaxy Health WC |
$237.15
|
| Rate for Payer: Global Benefits Group Commercial |
$167.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.96
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: Networks By Design Commercial |
$181.35
|
| Rate for Payer: Prime Health Services Commercial |
$237.15
|
|
