|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
OP
|
$50,530.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906820007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$10,106.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$22,738.50
|
| Rate for Payer: Cash Price |
$22,738.50
|
| Rate for Payer: Cash Price |
$22,738.50
|
| Rate for Payer: Central Health Plan Commercial |
$40,424.00
|
| Rate for Payer: Cigna of CA HMO |
$32,339.20
|
| Rate for Payer: Cigna of CA PPO |
$37,392.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,371.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$42,950.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30,318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,477.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$736.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32,086.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$813.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,106.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$37,897.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$32,844.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$42,950.50
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$25,265.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
IP
|
$50,530.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906820007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,106.00 |
| Max. Negotiated Rate |
$45,477.00 |
| Rate for Payer: Adventist Health Commercial |
$10,106.00
|
| Rate for Payer: Cash Price |
$22,738.50
|
| Rate for Payer: Central Health Plan Commercial |
$40,424.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,371.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,212.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,212.00
|
| Rate for Payer: Galaxy Health WC |
$42,950.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30,318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,477.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32,086.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,812.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,106.00
|
| Rate for Payer: Multiplan Commercial |
$37,897.50
|
| Rate for Payer: Networks By Design Commercial |
$32,844.50
|
| Rate for Payer: Prime Health Services Commercial |
$42,950.50
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
OP
|
$50,530.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906811476
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$10,106.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$22,738.50
|
| Rate for Payer: Cash Price |
$22,738.50
|
| Rate for Payer: Cash Price |
$22,738.50
|
| Rate for Payer: Central Health Plan Commercial |
$40,424.00
|
| Rate for Payer: Cigna of CA HMO |
$32,339.20
|
| Rate for Payer: Cigna of CA PPO |
$37,392.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,371.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$42,950.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30,318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,477.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$736.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32,086.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$813.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,106.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$37,897.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$32,844.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$42,950.50
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$25,265.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
IP
|
$50,530.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906811476
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,106.00 |
| Max. Negotiated Rate |
$45,477.00 |
| Rate for Payer: Adventist Health Commercial |
$10,106.00
|
| Rate for Payer: Cash Price |
$22,738.50
|
| Rate for Payer: Central Health Plan Commercial |
$40,424.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,371.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,212.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,212.00
|
| Rate for Payer: Galaxy Health WC |
$42,950.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30,318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,477.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32,086.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,812.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,106.00
|
| Rate for Payer: Multiplan Commercial |
$37,897.50
|
| Rate for Payer: Networks By Design Commercial |
$32,844.50
|
| Rate for Payer: Prime Health Services Commercial |
$42,950.50
|
|
|
HC VASC EMBOL OCC ART VEN HEM LYM EXTRVST
|
Facility
|
IP
|
$55,851.00
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
906811477
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,170.20 |
| Max. Negotiated Rate |
$50,265.90 |
| Rate for Payer: Adventist Health Commercial |
$11,170.20
|
| Rate for Payer: Cash Price |
$25,132.95
|
| Rate for Payer: Central Health Plan Commercial |
$44,680.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,095.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22,340.40
|
| Rate for Payer: Galaxy Health WC |
$47,473.35
|
| Rate for Payer: Global Benefits Group Commercial |
$33,510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50,265.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35,465.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,952.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,170.20
|
| Rate for Payer: Multiplan Commercial |
$41,888.25
|
| Rate for Payer: Networks By Design Commercial |
$36,303.15
|
| Rate for Payer: Prime Health Services Commercial |
$47,473.35
|
|
|
HC VASC EMBOL OCC ART VEN HEM LYM EXTRVST
|
Facility
|
OP
|
$55,851.00
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
906811477
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$11,170.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$25,132.95
|
| Rate for Payer: Cash Price |
$25,132.95
|
| Rate for Payer: Cash Price |
$25,132.95
|
| Rate for Payer: Central Health Plan Commercial |
$44,680.80
|
| Rate for Payer: Cigna of CA HMO |
$35,744.64
|
| Rate for Payer: Cigna of CA PPO |
$41,329.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,095.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$47,473.35
|
| Rate for Payer: Global Benefits Group Commercial |
$33,510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50,265.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,023.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35,465.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,131.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,170.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$41,888.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$36,303.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$47,473.35
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33,510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$27,925.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VASC EMBOL OCC PX W PRESSURE GEN CATH
|
Facility
|
IP
|
$48,085.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
906811600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,617.00 |
| Max. Negotiated Rate |
$43,276.50 |
| Rate for Payer: Adventist Health Commercial |
$9,617.00
|
| Rate for Payer: Cash Price |
$21,638.25
|
| Rate for Payer: Central Health Plan Commercial |
$38,468.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,659.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,234.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,234.00
|
| Rate for Payer: Galaxy Health WC |
$40,872.25
|
| Rate for Payer: Global Benefits Group Commercial |
$28,851.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,276.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,533.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,370.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,617.00
|
| Rate for Payer: Multiplan Commercial |
$36,063.75
|
| Rate for Payer: Networks By Design Commercial |
$31,255.25
|
| Rate for Payer: Prime Health Services Commercial |
$40,872.25
|
|
|
HC VASC EMBOL OCC PX W PRESSURE GEN CATH
|
Facility
|
OP
|
$48,085.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
906811600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$43,276.50 |
| Rate for Payer: Adventist Health Commercial |
$9,617.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,282.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,971.04
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$21,638.25
|
| Rate for Payer: Cash Price |
$21,638.25
|
| Rate for Payer: Cash Price |
$21,638.25
|
| Rate for Payer: Central Health Plan Commercial |
$38,468.00
|
| Rate for Payer: Cigna of CA HMO |
$30,774.40
|
| Rate for Payer: Cigna of CA PPO |
$35,582.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,659.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$40,872.25
|
| Rate for Payer: Global Benefits Group Commercial |
$28,851.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,276.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,533.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,617.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$36,063.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,255.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$40,872.25
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,851.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,042.50
|
| Rate for Payer: United Healthcare All Other HMO |
$24,042.50
|
| Rate for Payer: United Healthcare HMO Rider |
$24,042.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24,042.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC VASC EMBOL OCC VENOUS
|
Facility
|
IP
|
$44,324.00
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
906811475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,864.80 |
| Max. Negotiated Rate |
$39,891.60 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$35,459.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,729.60
|
| Rate for Payer: Galaxy Health WC |
$37,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,891.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,145.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,151.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,864.80
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
| Rate for Payer: Networks By Design Commercial |
$28,810.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,675.40
|
|
|
HC VASC EMBOL OCC VENOUS
|
Facility
|
OP
|
$44,324.00
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
906811475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$35,459.20
|
| Rate for Payer: Cigna of CA HMO |
$28,367.36
|
| Rate for Payer: Cigna of CA PPO |
$32,799.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$37,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,891.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,536.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,145.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,325.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,864.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$28,810.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$37,675.40
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,594.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,162.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VASCUTRAK PTA BALLOON
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909021725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,033.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.64
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
|
|
HC VASCUTRAK PTA BALLOON
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909021725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,157.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,390.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,033.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.64
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC VASOPNEUMATIC DEVICE MCAL
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901300043
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE MCAL
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901300043
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE MCARE COMM
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900407041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE MCARE COMM
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900407041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE OT
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
905104107
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE OT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901307016
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE OT
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
901307016
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE OT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
905104107
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE PT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900419065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE PT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
905103107
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE PT
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
900419065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VASOPNEUMATIC DEVICE PT
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
905103107
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$83.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Senior |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Riverside University Health System MISP |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC VAT PIV KIT
|
Facility
|
OP
|
$67.16
|
|
| Hospital Charge Code |
901698272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Adventist Health Commercial |
$13.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.07
|
| Rate for Payer: Blue Shield of California Commercial |
$42.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.80
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Central Health Plan Commercial |
$53.73
|
| Rate for Payer: Cigna of CA HMO |
$42.98
|
| Rate for Payer: Cigna of CA PPO |
$49.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.86
|
| Rate for Payer: EPIC Health Plan Senior |
$26.86
|
| Rate for Payer: Galaxy Health WC |
$57.09
|
| Rate for Payer: Global Benefits Group Commercial |
$40.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$50.37
|
| Rate for Payer: Networks By Design Commercial |
$43.65
|
| Rate for Payer: Prime Health Services Commercial |
$57.09
|
| Rate for Payer: Riverside University Health System MISP |
$26.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.58
|
| Rate for Payer: United Healthcare All Other HMO |
$33.58
|
| Rate for Payer: United Healthcare HMO Rider |
$33.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.09
|
| Rate for Payer: Vantage Medical Group Senior |
$57.09
|
|
