|
HC REPAIR PROFUNDUS TENDON
|
Facility
|
IP
|
$13,023.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,125.52 |
| Max. Negotiated Rate |
$11,069.55 |
| Rate for Payer: Cash Price |
$5,860.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,209.20
|
| Rate for Payer: Galaxy Health WC |
$11,069.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,813.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,686.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,961.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,125.52
|
| Rate for Payer: Multiplan Commercial |
$10,418.40
|
| Rate for Payer: Networks By Design Commercial |
$8,464.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,069.55
|
|
|
HC REPAIR PROFUNDUS TENDON
|
Facility
|
OP
|
$13,023.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,813.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,597.95
|
| Rate for Payer: Blue Shield of California EPN |
$7,605.43
|
| Rate for Payer: Cash Price |
$5,860.35
|
| Rate for Payer: Cash Price |
$5,860.35
|
| Rate for Payer: Cigna of CA PPO |
$9,637.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$11,069.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,813.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,767.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,551.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,551.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,686.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,125.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$10,418.40
|
| Rate for Payer: Networks By Design Commercial |
$8,464.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,069.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,813.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,813.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$559.20
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$699.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.68 |
| Max. Negotiated Rate |
$792.20 |
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
OP
|
$6,726.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.02 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,035.60
|
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Cigna of CA PPO |
$4,977.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$5,717.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,044.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,486.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$5,380.80
|
| Rate for Payer: Networks By Design Commercial |
$4,371.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,717.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,035.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,363.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,363.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,363.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,363.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$6,726.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,614.24 |
| Max. Negotiated Rate |
$5,717.10 |
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.40
|
| Rate for Payer: Galaxy Health WC |
$5,717.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,486.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.24
|
| Rate for Payer: Multiplan Commercial |
$5,380.80
|
| Rate for Payer: Networks By Design Commercial |
$4,371.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,717.10
|
|
|
HC REPAIR TENDON,LEG PRIM W/O GRF
|
Facility
|
IP
|
$8,189.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,965.36 |
| Max. Negotiated Rate |
$6,960.65 |
| Rate for Payer: Blue Shield of California Commercial |
$5,830.57
|
| Rate for Payer: Blue Shield of California EPN |
$4,192.77
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,275.60
|
| Rate for Payer: Galaxy Health WC |
$6,960.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,120.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,965.36
|
| Rate for Payer: Multiplan Commercial |
$6,551.20
|
| Rate for Payer: Networks By Design Commercial |
$5,322.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,960.65
|
|
|
HC REPAIR TENDON,LEG PRIM W/O GRF
|
Facility
|
OP
|
$8,189.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$548.21 |
| Max. Negotiated Rate |
$6,960.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,913.40
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Cigna of CA PPO |
$6,059.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$6,960.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,913.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,141.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,965.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$6,551.20
|
| Rate for Payer: Networks By Design Commercial |
$5,322.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,960.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,094.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,094.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,094.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,094.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR TENDON/MUSCLE PRIM SNGL
|
Facility
|
OP
|
$9,379.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.78 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,627.40
|
| Rate for Payer: Cash Price |
$4,220.55
|
| Rate for Payer: Cash Price |
$4,220.55
|
| Rate for Payer: Cash Price |
$4,220.55
|
| Rate for Payer: Cigna of CA PPO |
$6,940.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$7,972.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,627.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,034.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,255.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,250.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$7,503.20
|
| Rate for Payer: Networks By Design Commercial |
$6,096.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,972.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,627.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,689.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,689.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,689.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,689.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR TENDON/MUSCLE PRIM SNGL
|
Facility
|
IP
|
$9,379.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,250.96 |
| Max. Negotiated Rate |
$7,972.15 |
| Rate for Payer: Cash Price |
$4,220.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,751.60
|
| Rate for Payer: Galaxy Health WC |
$7,972.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,627.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,255.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,573.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,250.96
|
| Rate for Payer: Multiplan Commercial |
$7,503.20
|
| Rate for Payer: Networks By Design Commercial |
$6,096.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,972.15
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
OP
|
$2,717.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,630.20
|
| Rate for Payer: Cash Price |
$1,222.65
|
| Rate for Payer: Cash Price |
$1,222.65
|
| Rate for Payer: Cash Price |
$1,222.65
|
| Rate for Payer: Cigna of CA PPO |
$2,010.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$2,309.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,630.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,037.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,812.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$2,173.60
|
| Rate for Payer: Networks By Design Commercial |
$1,766.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,309.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,630.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,358.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,358.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,358.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,358.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
IP
|
$2,717.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$652.08 |
| Max. Negotiated Rate |
$2,309.45 |
| Rate for Payer: Cash Price |
$1,222.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,086.80
|
| Rate for Payer: Galaxy Health WC |
$2,309.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,630.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,812.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.08
|
| Rate for Payer: Multiplan Commercial |
$2,173.60
|
| Rate for Payer: Networks By Design Commercial |
$1,766.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,309.45
|
|
|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
948100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| 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 |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
948100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| 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 |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947300113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947300113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| 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 |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| 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 |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,965.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| 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 |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947200113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
