|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
OP
|
$32,366.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,244.75 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$19,419.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cigna of CA PPO |
$23,950.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24,274.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19,419.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
IP
|
$32,366.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,767.84 |
| Max. Negotiated Rate |
$27,511.10 |
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,946.40
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
OP
|
$28,001.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
909020066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$199.12 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$16,800.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cigna of CA PPO |
$20,720.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21,000.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: IEHP Medi-Cal |
$35,492.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,720.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$22,400.80
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16,800.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,800.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
IP
|
$28,001.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
909020066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,720.24 |
| Max. Negotiated Rate |
$23,800.85 |
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,200.40
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,668.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,720.24
|
| Rate for Payer: Multiplan Commercial |
$22,400.80
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
|
|
HC ATHRECTOMY ILIAC
|
Facility
OP
|
$32,366.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
909020081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,244.75 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,826.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$19,419.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cigna of CA PPO |
$23,950.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24,274.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: IEHP Medi-Cal |
$35,492.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19,419.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHRECTOMY ILIAC
|
Facility
IP
|
$32,366.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
909020081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,767.84 |
| Max. Negotiated Rate |
$27,511.10 |
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,946.40
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
|
|
HC ATHRECTOMY RENAL
|
Facility
IP
|
$32,366.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
909020077
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,767.84 |
| Max. Negotiated Rate |
$27,511.10 |
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,946.40
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
|
|
HC ATHRECTOMY RENAL
|
Facility
OP
|
$32,366.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
909020077
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,244.75 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$19,419.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cigna of CA PPO |
$23,950.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24,274.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19,419.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC ATHRECTOMY & STENT FEM/POP
|
Facility
IP
|
$49,537.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
909020068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,888.88 |
| Max. Negotiated Rate |
$42,106.45 |
| Rate for Payer: Cash Price |
$22,291.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,814.80
|
| Rate for Payer: Galaxy Health WC |
$42,106.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,722.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,041.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,873.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,888.88
|
| Rate for Payer: Multiplan Commercial |
$39,629.60
|
| Rate for Payer: Networks By Design Commercial |
$32,199.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,106.45
|
|
|
HC ATHRECTOMY & STENT FEM/POP
|
Facility
OP
|
$49,537.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
909020068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.46 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: BCBS Transplant Transplant |
$29,722.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$22,291.65
|
| Rate for Payer: Cash Price |
$22,291.65
|
| Rate for Payer: Cigna of CA PPO |
$36,657.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$42,106.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,722.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37,152.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: IEHP Medi-Cal |
$35,492.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,041.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,888.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$39,629.60
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$32,199.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,106.45
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$29,722.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,722.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHRECTOMY & STENT TIBIOPER EA
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
909020076
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,868.80 |
| Max. Negotiated Rate |
$13,702.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,868.80
|
| Rate for Payer: Multiplan Commercial |
$12,896.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC ATHRECTOMY & STENT TIBIOPER EA
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
909020076
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.11 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,866.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Dignity Health Media |
$13,702.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,702.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,090.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,868.80
|
| Rate for Payer: Multiplan Commercial |
$12,896.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,672.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,702.00
|
|
|
HC ATHRECTOMY & STENT TIBIOPERONE
|
Facility
IP
|
$49,537.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
909020072
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,888.88 |
| Max. Negotiated Rate |
$42,106.45 |
| Rate for Payer: Cash Price |
$22,291.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,814.80
|
| Rate for Payer: Galaxy Health WC |
$42,106.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,722.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,041.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,873.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,888.88
|
| Rate for Payer: Multiplan Commercial |
$39,629.60
|
| Rate for Payer: Networks By Design Commercial |
$32,199.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,106.45
|
|
|
HC ATHRECTOMY & STENT TIBIOPERONE
|
Facility
OP
|
$49,537.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
909020072
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: IEHP Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: BCBS Transplant Transplant |
$29,722.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$22,291.65
|
| Rate for Payer: Cash Price |
$22,291.65
|
| Rate for Payer: Cigna of CA PPO |
$36,657.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$42,106.45
|
| Rate for Payer: Global Benefits Group Commercial |
$29,722.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37,152.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: IEHP Medi-Cal |
$35,492.52
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,041.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,888.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$39,629.60
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$32,199.05
|
| Rate for Payer: Prime Health Services Commercial |
$42,106.45
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$29,722.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,722.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHRECTOMY TIBIOPERONEAL
|
Facility
IP
|
$28,001.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
909020070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,720.24 |
| Max. Negotiated Rate |
$23,800.85 |
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,200.40
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,668.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,720.24
|
| Rate for Payer: Multiplan Commercial |
$22,400.80
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
|
|
HC ATHRECTOMY TIBIOPERONEAL
|
Facility
OP
|
$28,001.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
909020070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.04 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: BCBS Transplant Transplant |
$16,800.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cigna of CA PPO |
$20,720.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21,000.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: IEHP Medi-Cal |
$35,492.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,720.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$22,400.80
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16,800.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,800.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
OP
|
$28,001.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
909020074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.58 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23,800.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,400.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15,400.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$16,800.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cigna of CA PPO |
$20,720.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,800.85
|
| Rate for Payer: Dignity Health Media |
$23,800.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,800.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,200.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,200.40
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21,000.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,720.24
|
| Rate for Payer: Multiplan Commercial |
$22,400.80
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16,800.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,800.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,800.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,800.85
|
| Rate for Payer: Vantage Medical Group Senior |
$23,800.85
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
IP
|
$28,001.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
909020074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,720.24 |
| Max. Negotiated Rate |
$23,800.85 |
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,200.40
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,668.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,720.24
|
| Rate for Payer: Multiplan Commercial |
$22,400.80
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
IP
|
$32,366.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,767.84 |
| Max. Negotiated Rate |
$27,511.10 |
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,946.40
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
OP
|
$32,366.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$27,511.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,034.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27,511.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17,801.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17,801.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$19,419.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cigna of CA PPO |
$23,950.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,511.10
|
| Rate for Payer: Dignity Health Media |
$27,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,511.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,946.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,946.40
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24,274.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19,419.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27,511.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$27,511.10
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
OP
|
$10,462.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$238.39 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,689.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,892.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,754.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,754.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,277.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Cigna of CA PPO |
$7,741.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,892.70
|
| Rate for Payer: Dignity Health Media |
$8,892.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,892.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,184.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,184.80
|
| Rate for Payer: Galaxy Health WC |
$8,892.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,277.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,846.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,978.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,510.88
|
| Rate for Payer: Multiplan Commercial |
$8,369.60
|
| Rate for Payer: Networks By Design Commercial |
$6,800.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,892.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,277.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,277.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,892.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,892.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,892.70
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
IP
|
$10,462.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,510.88 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,184.80
|
| Rate for Payer: Galaxy Health WC |
$8,892.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,277.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,978.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,986.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,510.88
|
| Rate for Payer: Multiplan Commercial |
$8,369.60
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,892.70
|
|
|
HC AUD EP NRO DGNTC W INT AND RPT
|
Facility
OP
|
$912.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
900600653
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$146.15 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$585.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$543.37
|
| Rate for Payer: BCBS Transplant Transplant |
$547.20
|
| Rate for Payer: Blue Shield of California Commercial |
$538.99
|
| Rate for Payer: Blue Shield of California EPN |
$427.73
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna of CA HMO |
$583.68
|
| Rate for Payer: Cigna of CA PPO |
$674.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$775.20
|
| Rate for Payer: Global Benefits Group Commercial |
$547.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$684.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: Networks By Design Commercial |
$592.80
|
| Rate for Payer: Prime Health Services Commercial |
$775.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$547.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$547.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$547.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$456.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC AUD EP NRO DGNTC W INT AND RPT
|
Facility
IP
|
$912.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
900600653
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$218.88 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.80
|
| Rate for Payer: Galaxy Health WC |
$775.20
|
| Rate for Payer: Global Benefits Group Commercial |
$547.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.88
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: Networks By Design Commercial |
$592.80
|
| Rate for Payer: Prime Health Services Commercial |
$775.20
|
|
|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
OP
|
$912.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$194.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$775.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$501.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$501.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$543.37
|
| Rate for Payer: BCBS Transplant Transplant |
$547.20
|
| Rate for Payer: Blue Shield of California Commercial |
$538.99
|
| Rate for Payer: Blue Shield of California EPN |
$427.73
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna of CA HMO |
$583.68
|
| Rate for Payer: Cigna of CA PPO |
$674.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$775.20
|
| Rate for Payer: Dignity Health Media |
$775.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$775.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$364.80
|
| Rate for Payer: Galaxy Health WC |
$775.20
|
| Rate for Payer: Global Benefits Group Commercial |
$547.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.88
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: Networks By Design Commercial |
$592.80
|
| Rate for Payer: Prime Health Services Commercial |
$775.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$547.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$547.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$547.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$456.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$775.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$775.20
|
| Rate for Payer: Vantage Medical Group Senior |
$775.20
|
|
