|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
940100113
|
|
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 |
949000305
|
|
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 |
947200113
|
|
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 |
947300113
|
|
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 |
947000113
|
|
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 |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| 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 |
$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: Cash Price |
$1,679.85
|
| 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 |
$973.00
|
| 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 |
$867.33
|
| 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 |
$1,866.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,866.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,866.50
|
| 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 |
909000255
|
|
Hospital Revenue Code
|
450
|
| 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
|
$2,484.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.80 |
| Max. Negotiated Rate |
$2,235.60 |
| Rate for Payer: Adventist Health Commercial |
$496.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$993.60
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,577.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,465.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946000113
|
|
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 |
909000255
|
|
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 |
949000305
|
|
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 |
946100113
|
|
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 |
909000255
|
|
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 |
946100113
|
|
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 TUNN W/PORT
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.87 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$786.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| 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 |
$3,144.90
|
| 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 |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,144.00
|
| Rate for Payer: Cigna of CA HMO |
$2,515.20
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,751.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,537.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,495.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,947.50
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,146.11
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,227.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.00
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$786.00 |
| Max. Negotiated Rate |
$3,537.00 |
| Rate for Payer: Adventist Health Commercial |
$786.00
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,144.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,751.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,537.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,495.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,318.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.00
|
| Rate for Payer: Multiplan Commercial |
$2,947.50
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
IP
|
$10,146.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,029.20 |
| Max. Negotiated Rate |
$9,131.40 |
| Rate for Payer: Adventist Health Commercial |
$2,029.20
|
| Rate for Payer: Cash Price |
$4,565.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,116.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,102.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,058.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,058.40
|
| Rate for Payer: Galaxy Health WC |
$8,624.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,087.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,131.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,442.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,986.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,029.20
|
| Rate for Payer: Multiplan Commercial |
$7,609.50
|
| Rate for Payer: Networks By Design Commercial |
$6,594.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,624.10
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
OP
|
$10,146.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.37 |
| Max. Negotiated Rate |
$9,131.40 |
| Rate for Payer: Adventist Health Commercial |
$2,029.20
|
| 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 |
$7,584.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,562.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,056.43
|
| 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 |
$7,634.30
|
| Rate for Payer: Cash Price |
$4,565.70
|
| Rate for Payer: Cash Price |
$4,565.70
|
| Rate for Payer: Cash Price |
$4,565.70
|
| Rate for Payer: Cash Price |
$4,565.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,116.80
|
| Rate for Payer: Cigna of CA HMO |
$6,493.44
|
| Rate for Payer: Cigna of CA PPO |
$7,508.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,562.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,056.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,102.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,343.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5,562.07
|
| Rate for Payer: Galaxy Health WC |
$8,624.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,087.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,131.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,292.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,056.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,442.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,435.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,029.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,775.62
|
| Rate for Payer: Multiplan Commercial |
$7,609.50
|
| Rate for Payer: Multiplan WC |
$7,634.30
|
| Rate for Payer: Networks By Design Commercial |
$6,594.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,056.43
|
| Rate for Payer: Preferred Health Network WC |
$7,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$8,624.10
|
| Rate for Payer: Prime Health Services Medicare |
$5,359.82
|
| Rate for Payer: Prime Health Services WC |
$7,556.40
|
| Rate for Payer: Riverside University Health System MISP |
$5,562.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,087.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,073.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,073.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,073.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,073.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,056.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,562.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5,056.43
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
IP
|
$6,405.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,281.00 |
| Max. Negotiated Rate |
$5,764.50 |
| Rate for Payer: Adventist Health Commercial |
$1,281.00
|
| Rate for Payer: Cash Price |
$2,882.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,124.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,483.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,562.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,562.00
|
| Rate for Payer: Galaxy Health WC |
$5,444.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,843.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,764.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,067.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,778.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$4,803.75
|
| Rate for Payer: Networks By Design Commercial |
$4,163.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,444.25
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
OP
|
$6,405.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,281.00
|
| 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 |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| 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 |
$6,372.03
|
| Rate for Payer: Cash Price |
$2,882.25
|
| Rate for Payer: Cash Price |
$2,882.25
|
| Rate for Payer: Cash Price |
$2,882.25
|
| Rate for Payer: Cash Price |
$2,882.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,124.00
|
| Rate for Payer: Cigna of CA HMO |
$4,099.20
|
| Rate for Payer: Cigna of CA PPO |
$4,739.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,483.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$5,444.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,843.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,764.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,067.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,158.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,365.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,803.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,163.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,444.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,843.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,202.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,202.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,202.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,202.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,012.60 |
| Max. Negotiated Rate |
$4,556.70 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,544.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,025.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.20
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,215.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,987.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,808.82 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| 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 |
$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 |
$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 |
$10,943.70
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: Cigna of CA HMO |
$3,240.32
|
| Rate for Payer: Cigna of CA PPO |
$3,746.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,544.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,215.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,980.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,693.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| 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 Commercial |
$4,303.55
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$3,037.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,531.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,531.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,531.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,531.50
|
| 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
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,012.60 |
| Max. Negotiated Rate |
$4,556.70 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,544.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,025.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.20
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,215.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,987.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.22 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| 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 |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| 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 |
$6,372.03
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: Cigna of CA HMO |
$3,240.32
|
| Rate for Payer: Cigna of CA PPO |
$3,746.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,544.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,215.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,365.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,037.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,531.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,531.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,531.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,531.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
IP
|
$2,163.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$1,946.70 |
| Rate for Payer: Adventist Health Commercial |
$432.60
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,730.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,514.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$865.20
|
| Rate for Payer: EPIC Health Plan Senior |
$865.20
|
| Rate for Payer: Galaxy Health WC |
$1,838.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,946.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,373.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,276.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.60
|
| Rate for Payer: Multiplan Commercial |
$1,622.25
|
| Rate for Payer: Networks By Design Commercial |
$1,405.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,838.55
|
|
