|
HC VENOUS ACCESS PORT
|
Facility
|
IP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cigna of CA HMO |
$1,241.10
|
| Rate for Payer: Cigna of CA PPO |
$1,241.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$709.20
|
| Rate for Payer: EPIC Health Plan Senior |
$709.20
|
| Rate for Payer: Galaxy Health WC |
$1,507.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,063.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,182.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,097.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.52
|
| Rate for Payer: Multiplan Commercial |
$1,418.40
|
| Rate for Payer: Networks By Design Commercial |
$886.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,507.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$665.41
|
| Rate for Payer: United Healthcare All Other HMO |
$647.68
|
| Rate for Payer: United Healthcare HMO Rider |
$633.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$580.66
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$411.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$266.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: Cigna of CA HMO |
$309.76
|
| Rate for Payer: Cigna of CA PPO |
$358.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$411.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$411.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$411.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$193.60
|
| Rate for Payer: Galaxy Health WC |
$411.40
|
| Rate for Payer: Global Benefits Group Commercial |
$290.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$299.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.80
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Networks By Design Commercial |
$314.60
|
| Rate for Payer: Prime Health Services Commercial |
$411.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$290.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$411.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$411.40
|
| Rate for Payer: Vantage Medical Group Senior |
$411.40
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$411.40 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$193.60
|
| Rate for Payer: Galaxy Health WC |
$411.40
|
| Rate for Payer: Global Benefits Group Commercial |
$290.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$299.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.16
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Networks By Design Commercial |
$314.60
|
| Rate for Payer: Prime Health Services Commercial |
$411.40
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$8,949.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,789.80 |
| Max. Negotiated Rate |
$7,606.65 |
| Rate for Payer: Adventist Health Commercial |
$1,789.80
|
| Rate for Payer: Cash Price |
$4,921.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,579.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,579.60
|
| Rate for Payer: Galaxy Health WC |
$7,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,369.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,968.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,409.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,539.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.76
|
| Rate for Payer: Multiplan Commercial |
$7,159.20
|
| Rate for Payer: Networks By Design Commercial |
$5,816.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,606.65
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$15,428.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,085.60 |
| Max. Negotiated Rate |
$13,113.80 |
| Rate for Payer: Adventist Health Commercial |
$3,085.60
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,171.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,171.20
|
| Rate for Payer: Galaxy Health WC |
$13,113.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,256.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,290.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,878.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,549.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,702.72
|
| Rate for Payer: Multiplan Commercial |
$12,342.40
|
| Rate for Payer: Networks By Design Commercial |
$10,028.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,113.80
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$15,428.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,822.94 |
| Max. Negotiated Rate |
$30,715.00 |
| Rate for Payer: Adventist Health Commercial |
$3,085.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Cigna of CA HMO |
$9,873.92
|
| Rate for Payer: Cigna of CA PPO |
$11,416.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$13,113.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,256.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,310.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,290.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,874.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,702.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$12,342.40
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$10,028.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,113.80
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,256.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$8,949.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,789.80 |
| Max. Negotiated Rate |
$30,715.00 |
| Rate for Payer: Adventist Health Commercial |
$1,789.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$4,921.95
|
| Rate for Payer: Cash Price |
$4,921.95
|
| Rate for Payer: Cash Price |
$4,921.95
|
| Rate for Payer: Cigna of CA HMO |
$5,727.36
|
| Rate for Payer: Cigna of CA PPO |
$6,622.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$7,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,369.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,310.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,968.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,874.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$7,159.20
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$5,816.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,606.65
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,369.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
OP
|
$9,966.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.81 |
| Max. Negotiated Rate |
$30,715.00 |
| Rate for Payer: Adventist Health Commercial |
$1,993.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$5,481.30
|
| Rate for Payer: Cash Price |
$5,481.30
|
| Rate for Payer: Cash Price |
$5,481.30
|
| Rate for Payer: Cigna of CA HMO |
$6,378.24
|
| Rate for Payer: Cigna of CA PPO |
$7,374.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,471.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,979.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$746.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,647.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,391.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,972.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,477.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,471.10
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,979.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
IP
|
$9,966.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,993.20 |
| Max. Negotiated Rate |
$8,471.10 |
| Rate for Payer: Adventist Health Commercial |
$1,993.20
|
| Rate for Payer: Cash Price |
$5,481.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,986.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,986.40
|
| Rate for Payer: Galaxy Health WC |
$8,471.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,979.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,647.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,797.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,168.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,391.84
|
| Rate for Payer: Multiplan Commercial |
$7,972.80
|
| Rate for Payer: Networks By Design Commercial |
$6,477.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,471.10
|
|
|
HC VENOUS PORT EXCHANGE
|
Facility
|
IP
|
$10,415.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,083.00 |
| Max. Negotiated Rate |
$8,852.75 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,166.00
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,946.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,968.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,446.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Multiplan Commercial |
$8,332.00
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
|
|
HC VENOUS PORT EXCHANGE
|
Facility
|
OP
|
$10,415.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$785.56 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,395.85
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cigna of CA HMO |
$6,665.60
|
| Rate for Payer: Cigna of CA PPO |
$7,707.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,946.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$8,332.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC VENOUS SAMPLING
|
Facility
|
OP
|
$10,028.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,005.60 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$2,005.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,577.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.16
|
| Rate for Payer: Blue Shield of California Commercial |
$6,137.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,051.31
|
| Rate for Payer: Cash Price |
$5,515.40
|
| Rate for Payer: Cash Price |
$5,515.40
|
| Rate for Payer: Cigna of CA HMO |
$6,417.92
|
| Rate for Payer: Cigna of CA PPO |
$7,420.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$8,523.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,016.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,688.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,406.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$8,022.40
|
| Rate for Payer: Networks By Design Commercial |
$6,518.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,523.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,016.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,016.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VENOUS SAMPLING
|
Facility
|
IP
|
$10,028.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,005.60 |
| Max. Negotiated Rate |
$8,523.80 |
| Rate for Payer: Adventist Health Commercial |
$2,005.60
|
| Rate for Payer: Cash Price |
$5,515.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,011.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,011.20
|
| Rate for Payer: Galaxy Health WC |
$8,523.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,016.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,688.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,820.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,207.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,406.72
|
| Rate for Payer: Multiplan Commercial |
$8,022.40
|
| Rate for Payer: Networks By Design Commercial |
$6,518.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,523.80
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$1,093.10 |
| Rate for Payer: Adventist Health Commercial |
$257.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$843.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$789.73
|
| Rate for Payer: Blue Shield of California Commercial |
$787.03
|
| Rate for Payer: Blue Shield of California EPN |
$519.54
|
| Rate for Payer: Cash Price |
$707.30
|
| Rate for Payer: Cash Price |
$707.30
|
| Rate for Payer: Cigna of CA HMO |
$823.04
|
| Rate for Payer: Cigna of CA PPO |
$951.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,093.10
|
| Rate for Payer: Global Benefits Group Commercial |
$771.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$857.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,028.80
|
| Rate for Payer: Networks By Design Commercial |
$835.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,093.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$771.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$771.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.46
|
| Rate for Payer: United Healthcare All Other HMO |
$396.46
|
| Rate for Payer: United Healthcare HMO Rider |
$396.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.20 |
| Max. Negotiated Rate |
$1,093.10 |
| Rate for Payer: Adventist Health Commercial |
$257.20
|
| Rate for Payer: Cash Price |
$707.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.40
|
| Rate for Payer: EPIC Health Plan Senior |
$514.40
|
| Rate for Payer: Galaxy Health WC |
$1,093.10
|
| Rate for Payer: Global Benefits Group Commercial |
$771.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$857.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.64
|
| Rate for Payer: Multiplan Commercial |
$1,028.80
|
| Rate for Payer: Networks By Design Commercial |
$835.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,093.10
|
|
|
HC VENOVENOUS COLLATERALS AT ABOVE HEART
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93587
|
| Hospital Charge Code |
906811587
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,835.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,092.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS AT ABOVE HEART
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93587
|
| Hospital Charge Code |
906811587
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,540.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS BELOW HEART
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93588
|
| Hospital Charge Code |
906811588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,835.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,092.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS BELOW HEART
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93588
|
| Hospital Charge Code |
906811588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,540.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
OP
|
$11,830.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$75.26 |
| Max. Negotiated Rate |
$10,055.50 |
| Rate for Payer: Adventist Health Commercial |
$2,366.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,759.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$6,506.50
|
| Rate for Payer: Cash Price |
$6,506.50
|
| Rate for Payer: Cash Price |
$6,506.50
|
| Rate for Payer: Cash Price |
$6,506.50
|
| Rate for Payer: Cigna of CA HMO |
$7,571.20
|
| Rate for Payer: Cigna of CA PPO |
$8,754.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.99
|
| Rate for Payer: EPIC Health Plan Senior |
$839.99
|
| Rate for Payer: Galaxy Health WC |
$10,055.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,098.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,377.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,890.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,839.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,125.59
|
| Rate for Payer: Multiplan Commercial |
$9,464.00
|
| Rate for Payer: Networks By Design Commercial |
$7,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,055.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,098.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,098.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$839.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
IP
|
$11,830.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,366.00 |
| Max. Negotiated Rate |
$10,055.50 |
| Rate for Payer: Adventist Health Commercial |
$2,366.00
|
| Rate for Payer: Cash Price |
$6,506.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,732.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,732.00
|
| Rate for Payer: Galaxy Health WC |
$10,055.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,098.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,890.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,507.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,322.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,839.20
|
| Rate for Payer: Multiplan Commercial |
$9,464.00
|
| Rate for Payer: Networks By Design Commercial |
$7,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,055.50
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
IP
|
$8,190.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,638.00 |
| Max. Negotiated Rate |
$6,961.50 |
| Rate for Payer: Adventist Health Commercial |
$1,638.00
|
| Rate for Payer: Cash Price |
$4,504.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,276.00
|
| Rate for Payer: Galaxy Health WC |
$6,961.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,914.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,120.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,069.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,965.60
|
| Rate for Payer: Multiplan Commercial |
$6,552.00
|
| Rate for Payer: Networks By Design Commercial |
$5,323.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,961.50
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
OP
|
$8,190.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.30 |
| Max. Negotiated Rate |
$6,961.50 |
| Rate for Payer: Adventist Health Commercial |
$1,638.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,371.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$4,504.50
|
| Rate for Payer: Cash Price |
$4,504.50
|
| Rate for Payer: Cash Price |
$4,504.50
|
| Rate for Payer: Cash Price |
$4,504.50
|
| Rate for Payer: Cigna of CA HMO |
$5,241.60
|
| Rate for Payer: Cigna of CA PPO |
$6,060.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.99
|
| Rate for Payer: EPIC Health Plan Senior |
$839.99
|
| Rate for Payer: Galaxy Health WC |
$6,961.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,914.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,377.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,965.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,125.59
|
| Rate for Payer: Multiplan Commercial |
$6,552.00
|
| Rate for Payer: Networks By Design Commercial |
$5,323.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,961.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,914.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,914.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$839.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$538.40 |
| Max. Negotiated Rate |
$2,288.20 |
| Rate for Payer: Adventist Health Commercial |
$538.40
|
| Rate for Payer: Cash Price |
$1,480.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,076.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,076.80
|
| Rate for Payer: Galaxy Health WC |
$2,288.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,795.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,025.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,666.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.08
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: Networks By Design Commercial |
$1,749.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,288.20
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$538.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,480.60
|
| Rate for Payer: Cash Price |
$1,480.60
|
| Rate for Payer: Cash Price |
$1,480.60
|
| Rate for Payer: Cigna of CA HMO |
$1,722.88
|
| Rate for Payer: Cigna of CA PPO |
$1,992.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,288.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,795.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,749.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,288.20
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,346.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,346.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,346.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,346.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
