|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| 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 |
$152.75
|
| 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 |
905352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| 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 |
$152.75
|
| 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
|
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 |
$142.25
|
| Rate for Payer: Blue Shield of California Commercial |
$180.72
|
| Rate for Payer: Blue Shield of California Commercial |
$119.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| 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 |
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 |
$142.25
|
| Rate for Payer: Blue Shield of California Commercial |
$180.72
|
| Rate for Payer: Blue Shield of California Commercial |
$119.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,649.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$14,196.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,190.63
|
| 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 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 |
$594.18 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,649.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$856.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,196.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$969.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,365.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$11,178.50
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
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 |
$594.18 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,097.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| 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 |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,840.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| 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/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$719.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,183.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$813.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,116.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| 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 |
$12,743.00
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,840.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$16,183.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,036.74
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,143.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23,715.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,035.32
|
| 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 |
$594.18 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Adventist Health Commercial |
$7,469.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| 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 |
$35,366.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,143.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| 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/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$719.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,715.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$813.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,963.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| 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 |
$18,674.00
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,719.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$17,888.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,620.89
|
| 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 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 |
$594.18 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,634.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,719.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,000.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,888.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,131.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,761.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$14,085.50
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,878.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$22,568.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,969.19
|
| 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 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 |
$4,753.44 |
| Max. Negotiated Rate |
$38,902.96 |
| Rate for Payer: Adventist Health Commercial |
$7,108.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,806.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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 |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,878.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| 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/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,568.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,529.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,649.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$14,196.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,190.63
|
| 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 |
$594.18 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,649.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,361.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,196.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,325.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,365.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$11,178.50
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
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 |
$1,534.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,285.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,949.41
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| 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 |
$478.00 |
| Rate for Payer: Networks By Design Commercial |
$181.35
|
| Rate for Payer: Adventist Health Commercial |
$114.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.75
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$177.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.61
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$177.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.61
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$177.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.61
|
| 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
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900407041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$114.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.75
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$177.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.61
|
| 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 VAT PIV KIT
|
Facility
|
OP
|
$67.16
|
|
| Hospital Charge Code |
901698272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$57.09 |
| Rate for Payer: Adventist Health Commercial |
$13.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.10
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cigna of CA HMO |
$42.98
|
| Rate for Payer: Cigna of CA PPO |
$49.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.86
|
| Rate for Payer: EPIC Health Plan Senior |
$26.86
|
| Rate for Payer: Galaxy Health WC |
$57.09
|
| Rate for Payer: Global Benefits Group Commercial |
$40.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$53.73
|
| Rate for Payer: Networks By Design Commercial |
$43.65
|
| Rate for Payer: Prime Health Services Commercial |
$57.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.58
|
| Rate for Payer: United Healthcare All Other HMO |
$33.58
|
| Rate for Payer: United Healthcare HMO Rider |
$33.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.09
|
| Rate for Payer: Vantage Medical Group Senior |
$57.09
|
|
|
HC VAT PIV KIT
|
Facility
|
IP
|
$67.16
|
|
| Hospital Charge Code |
901698272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$57.09 |
| Rate for Payer: Adventist Health Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.86
|
| Rate for Payer: EPIC Health Plan Senior |
$26.86
|
| Rate for Payer: Galaxy Health WC |
$57.09
|
| Rate for Payer: Global Benefits Group Commercial |
$40.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$53.73
|
| Rate for Payer: Networks By Design Commercial |
$43.65
|
| Rate for Payer: Prime Health Services Commercial |
$57.09
|
|
