|
HC VALPROIC ACID (DEPAKENE)
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$123.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.59
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Media |
$13.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.54
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.21
|
| Rate for Payer: IEHP Medi-Cal |
$21.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$21.93
|
| Rate for Payer: IEHP Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
IP
|
$19,142.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,594.08 |
| Max. Negotiated Rate |
$16,270.70 |
| Rate for Payer: Cash Price |
$8,613.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,656.80
|
| Rate for Payer: Galaxy Health WC |
$16,270.70
|
| Rate for Payer: Global Benefits Group Commercial |
$11,485.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,767.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,293.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,594.08
|
| Rate for Payer: Multiplan Commercial |
$15,313.60
|
| Rate for Payer: Networks By Design Commercial |
$12,442.30
|
| Rate for Payer: Prime Health Services Commercial |
$16,270.70
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
OP
|
$19,142.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,835.17 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,051.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: BCBS Transplant Transplant |
$11,485.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$8,613.90
|
| Rate for Payer: Cash Price |
$8,613.90
|
| Rate for Payer: Cigna of CA PPO |
$14,165.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$16,270.70
|
| Rate for Payer: Global Benefits Group Commercial |
$11,485.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14,356.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,711.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,711.81
|
| Rate for Payer: IEHP Medi-Cal |
$11,568.99
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,568.99
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,767.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,835.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,594.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$15,313.60
|
| Rate for Payer: Networks By Design Commercial |
$12,442.30
|
| Rate for Payer: Prime Health Services Commercial |
$16,270.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11,485.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,485.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,485.20
|
| 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 |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
IP
|
$12,761.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,062.64 |
| Max. Negotiated Rate |
$10,846.85 |
| Rate for Payer: Cash Price |
$5,742.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,104.40
|
| Rate for Payer: Galaxy Health WC |
$10,846.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,656.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,511.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,861.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.64
|
| Rate for Payer: Multiplan Commercial |
$10,208.80
|
| Rate for Payer: Networks By Design Commercial |
$8,294.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,846.85
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
OP
|
$12,761.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$396.66 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,341.11
|
| 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 |
$8,628.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,656.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$5,742.45
|
| Rate for Payer: Cash Price |
$5,742.45
|
| Rate for Payer: Cigna of CA PPO |
$9,443.14
|
| 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 |
$10,846.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,656.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,570.75
|
| 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 |
$8,511.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.64
|
| 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 |
$10,208.80
|
| Rate for Payer: Networks By Design Commercial |
$8,294.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,846.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,656.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,656.60
|
| 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 |
$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 VALVULOPLASTY, PULMONARY
|
Facility
IP
|
$14,106.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,385.44 |
| Max. Negotiated Rate |
$11,990.10 |
| Rate for Payer: Cash Price |
$6,347.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,642.40
|
| Rate for Payer: Galaxy Health WC |
$11,990.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,463.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,408.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,374.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,385.44
|
| Rate for Payer: Multiplan Commercial |
$11,284.80
|
| Rate for Payer: Networks By Design Commercial |
$9,168.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,990.10
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
OP
|
$14,106.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,556.14 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,271.58
|
| 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 |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,463.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$6,347.70
|
| Rate for Payer: Cash Price |
$6,347.70
|
| Rate for Payer: Cigna of CA PPO |
$10,438.44
|
| 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 |
$11,990.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,463.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,579.50
|
| 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 |
$9,408.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,556.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,385.44
|
| 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 |
$11,284.80
|
| Rate for Payer: Networks By Design Commercial |
$9,168.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,990.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,463.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,463.60
|
| 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 |
$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 VANCOMYCIN
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$123.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.59
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Media |
$13.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.54
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.21
|
| Rate for Payer: IEHP Medi-Cal |
$21.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$21.93
|
| Rate for Payer: IEHP Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VANILMANDELIC ACID
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$141.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.46
|
| Rate for Payer: BCBS Transplant Transplant |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$38.11
|
| Rate for Payer: Blue Shield of California EPN |
$30.21
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Media |
$15.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.50
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$25.42
|
| Rate for Payer: IEHP Medi-Cal |
$25.11
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$25.11
|
| Rate for Payer: IEHP Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.56
|
| Rate for Payer: United Healthcare All Other HMO |
$12.56
|
| Rate for Payer: United Healthcare HMO Rider |
$12.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.57
|
| Rate for Payer: BCBS Transplant Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Media |
$12.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.12
|
| Rate for Payer: IEHP Medi-Cal |
$20.87
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$20.87
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
IP
|
$27,687.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,644.88 |
| Max. Negotiated Rate |
$23,533.95 |
| Rate for Payer: Cash Price |
$12,459.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,074.80
|
| Rate for Payer: Galaxy Health WC |
$23,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16,612.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,467.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,548.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,644.88
|
| Rate for Payer: Multiplan Commercial |
$22,149.60
|
| Rate for Payer: Networks By Design Commercial |
$17,996.55
|
| Rate for Payer: Prime Health Services Commercial |
$23,533.95
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
OP
|
$27,687.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| 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 |
$8,241.00
|
| Rate for Payer: BCBS Transplant Transplant |
$16,612.20
|
| 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 |
$12,459.15
|
| Rate for Payer: Cash Price |
$12,459.15
|
| Rate for Payer: Cigna of CA PPO |
$20,488.38
|
| 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 |
$23,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16,612.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20,765.25
|
| 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 |
$18,467.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$969.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,644.88
|
| 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 |
$22,149.60
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$17,996.55
|
| Rate for Payer: Prime Health Services Commercial |
$23,533.95
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16,612.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,612.20
|
| 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 VASC EMBOL OCC ARTERIAL
|
Facility
IP
|
$31,563.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906811476
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,575.12 |
| Max. Negotiated Rate |
$26,828.55 |
| Rate for Payer: Cash Price |
$14,203.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,625.20
|
| Rate for Payer: Galaxy Health WC |
$26,828.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,937.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,052.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,025.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,575.12
|
| Rate for Payer: Multiplan Commercial |
$25,250.40
|
| Rate for Payer: Networks By Design Commercial |
$20,515.95
|
| Rate for Payer: Prime Health Services Commercial |
$26,828.55
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
OP
|
$31,563.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906811476
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| 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 |
$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 |
$18,937.80
|
| 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 |
$14,203.35
|
| Rate for Payer: Cash Price |
$14,203.35
|
| Rate for Payer: Cigna of CA PPO |
$23,356.62
|
| 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 |
$26,828.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,937.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23,672.25
|
| 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 |
$21,052.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,575.12
|
| 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 |
$25,250.40
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$20,515.95
|
| Rate for Payer: Prime Health Services Commercial |
$26,828.55
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18,937.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,937.80
|
| 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 VASC EMBOL OCC ART VEN HEM LYM EXTRVST
|
Facility
OP
|
$34,887.00
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
906811477
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| 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 |
$8,241.00
|
| Rate for Payer: BCBS Transplant Transplant |
$20,932.20
|
| 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 |
$15,699.15
|
| Rate for Payer: Cash Price |
$15,699.15
|
| Rate for Payer: Cigna of CA PPO |
$25,816.38
|
| 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 |
$29,653.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,932.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26,165.25
|
| 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 |
$23,269.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,131.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,372.88
|
| 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 |
$27,909.60
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$22,676.55
|
| Rate for Payer: Prime Health Services Commercial |
$29,653.95
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$20,932.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,932.20
|
| 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 VASC EMBOL OCC ART VEN HEM LYM EXTRVST
|
Facility
IP
|
$34,887.00
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
906811477
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,372.88 |
| Max. Negotiated Rate |
$29,653.95 |
| Rate for Payer: Cash Price |
$15,699.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,954.80
|
| Rate for Payer: Galaxy Health WC |
$29,653.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,932.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,269.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,291.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,372.88
|
| Rate for Payer: Multiplan Commercial |
$27,909.60
|
| Rate for Payer: Networks By Design Commercial |
$22,676.55
|
| Rate for Payer: Prime Health Services Commercial |
$29,653.95
|
|
|
HC VASC EMBOL OCC VENOUS
|
Facility
IP
|
$27,687.00
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
906811475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,644.88 |
| Max. Negotiated Rate |
$23,533.95 |
| Rate for Payer: Cash Price |
$12,459.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,074.80
|
| Rate for Payer: Galaxy Health WC |
$23,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16,612.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,467.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,548.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,644.88
|
| Rate for Payer: Multiplan Commercial |
$22,149.60
|
| Rate for Payer: Networks By Design Commercial |
$17,996.55
|
| Rate for Payer: Prime Health Services Commercial |
$23,533.95
|
|
|
HC VASC EMBOL OCC VENOUS
|
Facility
OP
|
$27,687.00
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
906811475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| 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 |
$8,241.00
|
| Rate for Payer: BCBS Transplant Transplant |
$16,612.20
|
| 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 |
$12,459.15
|
| Rate for Payer: Cash Price |
$12,459.15
|
| Rate for Payer: Cigna of CA PPO |
$20,488.38
|
| 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 |
$23,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16,612.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20,765.25
|
| 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 |
$18,467.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,325.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,644.88
|
| 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 |
$22,149.60
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$17,996.55
|
| Rate for Payer: Prime Health Services Commercial |
$23,533.95
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16,612.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,612.20
|
| 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 VASOPNEUMATIC DEVICE MCAL
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901300043
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
|
|
HC VASOPNEUMATIC DEVICE MCAL
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901300043
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$146.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$146.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$159.60
|
| 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 |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna of CA HMO |
$170.24
|
| Rate for Payer: Cigna of CA PPO |
$196.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.10
|
| Rate for Payer: Dignity Health Media |
$226.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$199.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$159.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.60
|
| 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 |
$226.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.10
|
| Rate for Payer: Vantage Medical Group Senior |
$226.10
|
|
|
HC VASOPNEUMATIC DEVICE MCARE COMM
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900407041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$146.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$146.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$159.60
|
| 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 |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna of CA HMO |
$170.24
|
| Rate for Payer: Cigna of CA PPO |
$196.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.10
|
| Rate for Payer: Dignity Health Media |
$226.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$199.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$159.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.60
|
| 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 |
$226.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.10
|
| Rate for Payer: Vantage Medical Group Senior |
$226.10
|
|
|
HC VASOPNEUMATIC DEVICE MCARE COMM
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900407041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
|
|
HC VEEG 21-12HR INTMT MNTRD
|
Facility
OP
|
$944.00
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
900605712
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$3,179.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,179.59
|
| 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 |
$562.44
|
| Rate for Payer: BCBS Transplant Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$557.90
|
| Rate for Payer: Blue Shield of California EPN |
$442.74
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| 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 |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$708.00
|
| 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 |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| 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 |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| 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 VEEG 21-12HR INTMT MNTRD
|
Facility
IP
|
$944.00
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
900605712
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC VEEG 21-12HR UNMNTRD
|
Facility
IP
|
$944.00
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
900605711
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
