|
HC STENT ILIAC EA ADDL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,675.36 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.27 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,188.40
|
| 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 |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Media |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
IP
|
$9,972.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,393.28 |
| Max. Negotiated Rate |
$8,476.20 |
| Rate for Payer: Cash Price |
$4,487.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,988.80
|
| Rate for Payer: Galaxy Health WC |
$8,476.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,983.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,651.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,799.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.28
|
| Rate for Payer: Multiplan Commercial |
$7,977.60
|
| Rate for Payer: Networks By Design Commercial |
$6,481.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,476.20
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
OP
|
$9,972.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,046.20 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,983.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$4,487.40
|
| Rate for Payer: Cash Price |
$4,487.40
|
| Rate for Payer: Cigna of CA PPO |
$7,379.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$8,476.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,983.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,479.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,056.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,651.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,046.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$7,977.60
|
| Rate for Payer: Networks By Design Commercial |
$6,481.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,476.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,983.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
IP
|
$7,313.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,755.12 |
| Max. Negotiated Rate |
$6,216.05 |
| Rate for Payer: Cash Price |
$3,290.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,925.20
|
| Rate for Payer: Galaxy Health WC |
$6,216.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,387.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,786.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,755.12
|
| Rate for Payer: Multiplan Commercial |
$5,850.40
|
| Rate for Payer: Networks By Design Commercial |
$4,753.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,216.05
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
OP
|
$7,313.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,755.12 |
| Max. Negotiated Rate |
$8,208.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,208.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,216.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,022.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,387.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,290.85
|
| Rate for Payer: Cash Price |
$3,290.85
|
| Rate for Payer: Cash Price |
$3,290.85
|
| Rate for Payer: Cigna of CA PPO |
$5,411.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,216.05
|
| Rate for Payer: Dignity Health Media |
$6,216.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,216.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,925.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,925.20
|
| Rate for Payer: Galaxy Health WC |
$6,216.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,387.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,484.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,877.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,755.12
|
| Rate for Payer: Multiplan Commercial |
$5,850.40
|
| Rate for Payer: Networks By Design Commercial |
$4,753.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,216.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,387.80
|
| 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 |
$6,216.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,216.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,216.05
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cigna of CA PPO |
$12,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: Dignity Health Media |
$14,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,802.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,200.00
|
| Rate for Payer: Multiplan Commercial |
$14,000.00
|
| Rate for Payer: Networks By Design Commercial |
$11,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,500.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,667.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,200.00
|
| Rate for Payer: Multiplan Commercial |
$14,000.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.79 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cigna of CA PPO |
$12,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: Dignity Health Media |
$14,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,200.00
|
| Rate for Payer: Multiplan Commercial |
$14,000.00
|
| Rate for Payer: Networks By Design Commercial |
$11,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,500.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,667.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,200.00
|
| Rate for Payer: Multiplan Commercial |
$14,000.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
IP
|
$28,001.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
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 STENT TIBIOPERONEAL
|
Facility
|
OP
|
$28,001.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,129.68 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care 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: Blue Distinction 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) 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,129.68
|
| 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: 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 STENT TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
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 STENT TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.79 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,866.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction 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) 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 |
$447.79
|
| 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: 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 STERNO CLAV JOINTS
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$698.70 |
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.80
|
| Rate for Payer: Galaxy Health WC |
$698.70
|
| Rate for Payer: Global Benefits Group Commercial |
$493.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.28
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: Networks By Design Commercial |
$534.30
|
| Rate for Payer: Prime Health Services Commercial |
$698.70
|
|
|
HC STERNO CLAV JOINTS
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$698.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$169.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.37
|
| Rate for Payer: Blue Distinction Transplant |
$493.20
|
| Rate for Payer: Blue Shield of California Commercial |
$485.80
|
| Rate for Payer: Blue Shield of California EPN |
$385.52
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna of CA HMO |
$526.08
|
| Rate for Payer: Cigna of CA PPO |
$608.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$698.70
|
| Rate for Payer: Global Benefits Group Commercial |
$493.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$616.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: Networks By Design Commercial |
$534.30
|
| Rate for Payer: Prime Health Services Commercial |
$698.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$493.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$493.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC STERNUM
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$814.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$141.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.71
|
| Rate for Payer: Blue Distinction Transplant |
$574.80
|
| Rate for Payer: Blue Shield of California Commercial |
$566.18
|
| Rate for Payer: Blue Shield of California EPN |
$449.30
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cigna of CA HMO |
$613.12
|
| Rate for Payer: Cigna of CA PPO |
$708.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$814.30
|
| Rate for Payer: Global Benefits Group Commercial |
$574.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$718.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: Networks By Design Commercial |
$622.70
|
| Rate for Payer: Prime Health Services Commercial |
$814.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC STERNUM
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.92 |
| Max. Negotiated Rate |
$814.30 |
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.20
|
| Rate for Payer: Galaxy Health WC |
$814.30
|
| Rate for Payer: Global Benefits Group Commercial |
$574.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.92
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: Networks By Design Commercial |
$622.70
|
| Rate for Payer: Prime Health Services Commercial |
$814.30
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,527.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,046.48 |
| Max. Negotiated Rate |
$7,247.95 |
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,248.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.48
|
| Rate for Payer: Multiplan Commercial |
$6,821.60
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$8,527.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,247.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,689.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,689.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,116.20
|
| 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 |
$3,837.15
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cigna of CA PPO |
$6,309.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Dignity Health Media |
$7,247.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,395.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,716.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.48
|
| Rate for Payer: Multiplan Commercial |
$6,821.60
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,116.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,247.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,247.95
|
|
|
HC STRAPPING ANKLE
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900501219
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.20 |
| Max. Negotiated Rate |
$620.50 |
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.00
|
| Rate for Payer: Galaxy Health WC |
$620.50
|
| Rate for Payer: Global Benefits Group Commercial |
$438.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: Networks By Design Commercial |
$474.50
|
| Rate for Payer: Prime Health Services Commercial |
$620.50
|
|
|
HC STRAPPING ANKLE
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900501219
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.66 |
| 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 |
$438.00
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cigna of CA PPO |
$540.20
|
| 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 |
$620.50
|
| Rate for Payer: Global Benefits Group Commercial |
$438.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$547.50
|
| 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 |
$486.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| 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 |
$584.00
|
| Rate for Payer: Networks By Design Commercial |
$474.50
|
| Rate for Payer: Prime Health Services Commercial |
$620.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$438.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.00
|
| Rate for Payer: United Healthcare All Other HMO |
$365.00
|
| Rate for Payer: United Healthcare HMO Rider |
$365.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$365.00
|
| 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 STRAPPING ELBOW OR WRIST
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901301209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$219.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$534.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna of CA HMO |
$569.60
|
| Rate for Payer: Cigna of CA PPO |
$658.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$667.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: Networks By Design Commercial |
$578.50
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC STRAPPING ELBOW OR WRIST
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901301209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$756.50 |
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: Networks By Design Commercial |
$578.50
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
900501366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
|
