|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$863.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$782.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$727.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$8,895.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,779.00 |
| Max. Negotiated Rate |
$8,005.50 |
| Rate for Payer: Adventist Health Commercial |
$1,779.00
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,116.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,226.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,558.00
|
| Rate for Payer: Galaxy Health WC |
$7,560.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,005.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,648.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,248.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,779.00
|
| Rate for Payer: Multiplan Commercial |
$6,671.25
|
| Rate for Payer: Networks By Design Commercial |
$5,781.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,560.75
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
OP
|
$8,895.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.02 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,779.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| 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 |
$6,568.63
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,116.00
|
| Rate for Payer: Cigna of CA HMO |
$5,692.80
|
| Rate for Payer: Cigna of CA PPO |
$6,582.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,226.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$7,560.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,005.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,648.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,779.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,671.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,781.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$7,560.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,337.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,447.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,447.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,447.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,447.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
OP
|
$8,895.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$348.02 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$3,646.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,764.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| 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 |
$6,568.63
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,116.00
|
| Rate for Payer: Cigna of CA HMO |
$5,692.80
|
| Rate for Payer: Cigna of CA PPO |
$6,582.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,226.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$7,560.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,005.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,648.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,779.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,671.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,781.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$7,560.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,337.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,337.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$8,895.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,779.00 |
| Max. Negotiated Rate |
$8,005.50 |
| Rate for Payer: Adventist Health Commercial |
$1,779.00
|
| Rate for Payer: Cash Price |
$4,002.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,116.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,226.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,558.00
|
| Rate for Payer: Galaxy Health WC |
$7,560.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,005.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,648.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,248.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,779.00
|
| Rate for Payer: Multiplan Commercial |
$6,671.25
|
| Rate for Payer: Networks By Design Commercial |
$5,781.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,560.75
|
|
|
HC REPAIR TENDON,LEG PRIM W/O GRF
|
Facility
|
OP
|
$10,830.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,747.00 |
| Rate for Payer: Adventist Health Commercial |
$2,166.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,664.00
|
| Rate for Payer: Cigna of CA HMO |
$6,931.20
|
| Rate for Payer: Cigna of CA PPO |
$8,014.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$9,205.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,747.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,877.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$548.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$8,122.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$7,039.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$9,205.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,415.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR TENDON,LEG PRIM W/O GRF
|
Facility
|
IP
|
$10,830.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,166.00 |
| Max. Negotiated Rate |
$9,747.00 |
| Rate for Payer: Adventist Health Commercial |
$2,166.00
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,664.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,332.00
|
| Rate for Payer: Galaxy Health WC |
$9,205.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,747.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,877.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,389.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,166.00
|
| Rate for Payer: Multiplan Commercial |
$8,122.50
|
| Rate for Payer: Networks By Design Commercial |
$7,039.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,205.50
|
|
|
HC REPAIR TENDON/MUSCLE PRIM SNGL
|
Facility
|
OP
|
$8,910.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.78 |
| Max. Negotiated Rate |
$8,924.00 |
| Rate for Payer: Adventist Health Commercial |
$1,782.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| 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 |
$6,568.63
|
| Rate for Payer: Cash Price |
$4,009.50
|
| Rate for Payer: Cash Price |
$4,009.50
|
| Rate for Payer: Cash Price |
$4,009.50
|
| Rate for Payer: Cash Price |
$4,009.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,128.00
|
| Rate for Payer: Cigna of CA HMO |
$5,702.40
|
| Rate for Payer: Cigna of CA PPO |
$6,593.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,237.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$7,573.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,346.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,019.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,657.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,682.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,791.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$7,573.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,346.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,455.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,455.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,455.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,455.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR TENDON/MUSCLE PRIM SNGL
|
Facility
|
IP
|
$8,910.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,782.00 |
| Max. Negotiated Rate |
$8,019.00 |
| Rate for Payer: Adventist Health Commercial |
$1,782.00
|
| Rate for Payer: Cash Price |
$4,009.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,128.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,237.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,564.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,564.00
|
| Rate for Payer: Galaxy Health WC |
$7,573.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,346.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,019.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,657.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,256.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.00
|
| Rate for Payer: Multiplan Commercial |
$6,682.50
|
| Rate for Payer: Networks By Design Commercial |
$5,791.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,573.50
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
OP
|
$4,349.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$869.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| 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 |
$470.13
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,479.20
|
| Rate for Payer: Cigna of CA HMO |
$2,783.36
|
| Rate for Payer: Cigna of CA PPO |
$3,218.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,044.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$3,696.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,609.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,914.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,761.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$363.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$3,261.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,826.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.63
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$3,696.65
|
| Rate for Payer: Prime Health Services Medicare |
$322.91
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$335.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,609.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,174.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,174.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,174.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,174.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
IP
|
$4,349.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$869.80 |
| Max. Negotiated Rate |
$3,914.10 |
| Rate for Payer: Adventist Health Commercial |
$869.80
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,479.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,044.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,739.60
|
| Rate for Payer: Galaxy Health WC |
$3,696.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,609.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,914.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,761.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,565.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.80
|
| Rate for Payer: Multiplan Commercial |
$3,261.75
|
| Rate for Payer: Networks By Design Commercial |
$2,826.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,696.65
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
OP
|
$4,349.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,783.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,237.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| 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 |
$470.13
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,479.20
|
| Rate for Payer: Cigna of CA HMO |
$2,783.36
|
| Rate for Payer: Cigna of CA PPO |
$3,218.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,044.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$3,696.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,609.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,914.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,761.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$363.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$3,261.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,826.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.63
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$3,696.65
|
| Rate for Payer: Prime Health Services Medicare |
$322.91
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$335.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,609.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,609.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
IP
|
$4,349.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$869.80 |
| Max. Negotiated Rate |
$3,914.10 |
| Rate for Payer: Adventist Health Commercial |
$869.80
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,479.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,044.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,739.60
|
| Rate for Payer: Galaxy Health WC |
$3,696.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,609.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,914.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,761.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,565.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.80
|
| Rate for Payer: Multiplan Commercial |
$3,261.75
|
| Rate for Payer: Networks By Design Commercial |
$2,826.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,696.65
|
|
|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
948100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,202.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
948100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Cigna of CA HMO |
$2,389.12
|
| Rate for Payer: Cigna of CA PPO |
$2,762.42
|
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| 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 |
$1,251.66
|
| 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: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,239.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,866.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| 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 |
$1,251.66
|
| 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: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Cigna of CA HMO |
$2,389.12
|
| Rate for Payer: Cigna of CA PPO |
$2,762.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,239.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,866.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,202.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Adventist Health Commercial |
$496.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| 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 |
$1,251.66
|
| 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: Cash Price |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO |
$1,589.76
|
| Rate for Payer: Cigna of CA PPO |
$1,838.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,577.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,242.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947200113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| 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 |
$1,251.66
|
| 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: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Cigna of CA HMO |
$2,389.12
|
| Rate for Payer: Cigna of CA PPO |
$2,762.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,239.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,866.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
940100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,202.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,202.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| 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 |
$1,251.66
|
| 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: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Cigna of CA HMO |
$2,389.12
|
| Rate for Payer: Cigna of CA PPO |
$2,762.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,239.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,866.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| 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 |
$1,251.66
|
| 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: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Cigna of CA HMO |
$2,389.12
|
| Rate for Payer: Cigna of CA PPO |
$2,762.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,239.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,866.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947300113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,202.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,202.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
