|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC VASCULAR TERRITORY, WITH TRANSLUMINAL STENT PLACEMENT, INCLUDING TRANSLUMINAL ANGIOPLASTY WHEN PERFORMED, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENT PLACEMENT AND ANGIOPLASTY WHEN PERFORMED, WITHIN THE SAME ARTERY, UNILATERAL; COMPLEX LESION, INITIAL VESSEL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| 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 |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| 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: 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: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| 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
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, INFRAMALLEOLAR VASCULAR TERRITORY, WITH TRANSLUMINAL ANGIOPLASTY, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY, UNILATERAL; COMPLEX LESION, INITIAL VESSEL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37298
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| 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 |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| 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: 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: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| 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
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, LOWER EXTREMITY ARTERY(IES), EXCEPT TIBIAL/PERONEAL; WITH INTRAVASCULAR LITHOTRIPSY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL(S), WHEN PERFORMED
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT C9764
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$28,817.00 |
| 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 |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| 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: 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: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| 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 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: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| 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
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL AND PERONEAL VASCULAR TERRITORY, WITH TRANSLUMINAL ANGIOPLASTY, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY, UNILATERAL; COMPLEX LESION, EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37283
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL AND PERONEAL VASCULAR TERRITORY, WITH TRANSLUMINAL ANGIOPLASTY, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY, UNILATERAL; COMPLEX LESION, INITIAL VESSEL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| 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 |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| 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: 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: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| 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
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL AND PERONEAL VASCULAR TERRITORY, WITH TRANSLUMINAL ANGIOPLASTY, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY, UNILATERAL; STRAIGHTFORWARD LESION, EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL AND PERONEAL VASCULAR TERRITORY, WITH TRANSLUMINAL ANGIOPLASTY, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY, UNILATERAL; STRAIGHTFORWARD LESION, INITIAL VESSEL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| 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 |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| 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: 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: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| 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
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY(IES), WITH INTRAVASCULAR LITHOTRIPSY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL (S), WHEN PERFORMED
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT C9772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$50,447.00 |
| 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 |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| 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: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| 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 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: 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
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 37232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 37228
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
|
|
REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR; WITH GRAFT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 66185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.15 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,968.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$491.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,155.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
REVISION OF ARTHROPLASTY, INCLUDING REMOVAL OF IMPLANT, WRIST JOINT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 25449
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,709.11 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| 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 |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,709.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,887.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
REVISION OF COLOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 44340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$293.93 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,557.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,411.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,013.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,474.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$293.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,380.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,107.48
|
| Rate for Payer: Multiplan WC |
$7,411.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Preferred Health Network WC |
$7,562.79
|
| Rate for Payer: Prime Health Services Medicare |
$4,831.29
|
| Rate for Payer: Prime Health Services WC |
$7,335.91
|
| Rate for Payer: Riverside University Health System MISP |
$5,013.60
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,557.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH CC
|
Facility
|
IP
|
$92,816.59
|
|
|
Service Code
|
MSDRG 467
|
| Min. Negotiated Rate |
$32,499.00 |
| Max. Negotiated Rate |
$92,816.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92,816.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59,955.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83,940.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$81,742.04
|
| Rate for Payer: EPIC Health Plan Senior |
$54,494.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49,540.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69,356.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66,384.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49,540.63
|
| Rate for Payer: Prime Health Services Medicare |
$52,513.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$36,468.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36,468.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,474.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,499.00
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$137,000.92
|
|
|
Service Code
|
MSDRG 466
|
| Min. Negotiated Rate |
$39,477.00 |
| Max. Negotiated Rate |
$137,000.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$137,000.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88,497.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123,898.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$119,946.29
|
| Rate for Payer: EPIC Health Plan Senior |
$79,964.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,694.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101,772.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$97,410.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$72,694.72
|
| Rate for Payer: Prime Health Services Medicare |
$77,056.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39,477.00
|
| Rate for Payer: United Healthcare HMO Rider |
$45,640.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41,813.00
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$72,324.61
|
|
|
Service Code
|
MSDRG 468
|
| Min. Negotiated Rate |
$28,986.00 |
| Max. Negotiated Rate |
$72,324.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,324.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46,718.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65,407.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$64,023.53
|
| Rate for Payer: EPIC Health Plan Senior |
$42,682.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,802.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,323.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51,994.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38,802.14
|
| Rate for Payer: Prime Health Services Medicare |
$41,130.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$39,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39,477.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,639.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,986.00
|
|
|
REVISION OF PERI-IMPLANT CAPSULE, BREAST, INCLUDING CAPSULOTOMY, CAPSULORRHAPHY, AND/OR PARTIAL CAPSULECTOMY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 19370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$87.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
REVISION OF RECONSTRUCTED BREAST (EG, SIGNIFICANT REMOVAL OF TISSUE, RE-ADVANCEMENT AND/OR RE-INSET OF FLAPS IN AUTOLOGOUS RECONSTRUCTION OR SIGNIFICANT CAPSULAR REVISION COMBINED WITH SOFT TISSUE EXCISION IN IMPLANT-BASED RECONSTRUCTION)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 19380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.09 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,540.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,540.37
|
| 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 |
$13,202.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,394.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,540.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,091.61
|
| Rate for Payer: EPIC Health Plan Senior |
$9,394.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,006.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$176.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,540.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,956.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,444.10
|
| Rate for Payer: Multiplan WC |
$13,202.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8,540.37
|
| Rate for Payer: Preferred Health Network WC |
$13,471.96
|
| Rate for Payer: Prime Health Services Medicare |
$9,052.79
|
| Rate for Payer: Prime Health Services WC |
$13,067.80
|
| Rate for Payer: Riverside University Health System MISP |
$9,394.41
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,540.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,810.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,394.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8,540.37
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT 27486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,512.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| 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: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,245.94
|
| Rate for Payer: EPIC Health Plan Senior |
$18,163.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27,080.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,117.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Prime Health Services Medicare |
$17,503.45
|
| Rate for Payer: Riverside University Health System MISP |
$18,163.96
|
| 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 |
$16,512.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT 27487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.15 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,551.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,551.42
|
| 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: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,806.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,551.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,209.84
|
| Rate for Payer: EPIC Health Plan Senior |
$24,806.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,984.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$491.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,571.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,218.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Prime Health Services Medicare |
$23,904.51
|
| Rate for Payer: Riverside University Health System MISP |
$24,806.56
|
| 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 |
$22,551.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Vantage Medical Group Senior |
$22,551.42
|
|
|
REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL OR GLENOID COMPONENT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 23473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$466.17 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,512.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$26,048.55
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,245.94
|
| Rate for Payer: EPIC Health Plan Senior |
$18,163.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27,080.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$466.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,117.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Preferred Health Network WC |
$26,580.15
|
| Rate for Payer: Prime Health Services Medicare |
$17,503.45
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: Riverside University Health System MISP |
$18,163.96
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$16,512.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 36832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.32 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$31,085.00
|
|
|
Service Code
|
CPT 61888
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$523.81 |
| Max. Negotiated Rate |
$31,085.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,331.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,497.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,764.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,331.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,085.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$25,245.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,497.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,764.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,331.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,646.76
|
| Rate for Payer: EPIC Health Plan Senior |
$15,764.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,503.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$523.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,331.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$578.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,063.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,204.04
|
| Rate for Payer: Multiplan WC |
$25,245.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,331.37
|
| Rate for Payer: Preferred Health Network WC |
$25,761.05
|
| Rate for Payer: Prime Health Services Medicare |
$15,191.25
|
| Rate for Payer: Prime Health Services WC |
$24,988.22
|
| Rate for Payer: Riverside University Health System MISP |
$15,764.51
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,331.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,497.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,764.51
|
| Rate for Payer: Vantage Medical Group Senior |
$14,331.37
|
|
|
REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 63688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,496.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,496.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,962.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,946.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,496.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,419.36
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,374.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,496.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,295.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,025.42
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,496.58
|
| Rate for Payer: Preferred Health Network WC |
$7,104.27
|
| Rate for Payer: Prime Health Services Medicare |
$4,766.37
|
| Rate for Payer: Prime Health Services WC |
$6,891.14
|
| Rate for Payer: Riverside University Health System MISP |
$4,946.24
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,496.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4,496.58
|
|
|
REVISION OR REMOVAL OF INTRACRANIAL NEUROSTIMULATOR ELECTRODES
|
Facility
|
OP
|
$31,085.00
|
|
|
Service Code
|
CPT 61880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$669.82 |
| Max. Negotiated Rate |
$31,085.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,496.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,496.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,085.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,962.18
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,946.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,496.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,419.36
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,374.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$669.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,496.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$739.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,295.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,025.42
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,496.58
|
| Rate for Payer: Preferred Health Network WC |
$7,104.27
|
| Rate for Payer: Prime Health Services Medicare |
$4,766.37
|
| Rate for Payer: Prime Health Services WC |
$6,891.14
|
| Rate for Payer: Riverside University Health System MISP |
$4,946.24
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,496.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4,496.58
|
|
