|
HC VENOGRAM RENAL UNILAT
|
Facility
|
IP
|
$6,571.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,314.20 |
| Max. Negotiated Rate |
$5,585.35 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,599.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,628.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,628.40
|
| Rate for Payer: Galaxy Health WC |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,172.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,876.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.04
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
|
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,106.16 |
| Max. Negotiated Rate |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,106.16
|
| 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 HMO/PPO |
$3,719.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2,766.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Cigna of CA HMO |
$4,205.44
|
| Rate for Payer: Cigna of CA PPO |
$4,862.54
|
| 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 |
$4,599.70
|
| 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 |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,172.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,942.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,942.60
|
| 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 |
$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 VENOGRAM SUPERIOR VENACAVA
|
Facility
|
IP
|
$5,519.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,103.80 |
| Max. Negotiated Rate |
$4,691.15 |
| Rate for Payer: Adventist Health Commercial |
$1,103.80
|
| Rate for Payer: Cash Price |
$2,483.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,863.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,207.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,207.60
|
| Rate for Payer: Galaxy Health WC |
$4,691.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,504.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,256.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.56
|
| Rate for Payer: Multiplan Commercial |
$4,415.20
|
| Rate for Payer: Networks By Design Commercial |
$3,587.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,691.15
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
|
OP
|
$5,519.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$4,691.15 |
| Rate for Payer: Adventist Health Commercial |
$1,103.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,103.73
|
| 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 HMO/PPO |
$3,700.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2,323.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,521.12
|
| Rate for Payer: Cash Price |
$2,483.55
|
| Rate for Payer: Cash Price |
$2,483.55
|
| Rate for Payer: Cigna of CA HMO |
$3,532.16
|
| Rate for Payer: Cigna of CA PPO |
$4,084.06
|
| 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 |
$3,863.30
|
| 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 |
$4,691.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,504.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,415.20
|
| Rate for Payer: Networks By Design Commercial |
$3,587.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,691.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,311.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| 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 VENOGRAM SUP SAG SINUS
|
Facility
|
IP
|
$3,611.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$722.20 |
| Max. Negotiated Rate |
$3,069.35 |
| Rate for Payer: Adventist Health Commercial |
$722.20
|
| Rate for Payer: Cash Price |
$1,624.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,527.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,444.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,444.40
|
| Rate for Payer: Galaxy Health WC |
$3,069.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,166.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,292.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,130.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$866.64
|
| Rate for Payer: Multiplan Commercial |
$2,888.80
|
| Rate for Payer: Networks By Design Commercial |
$2,347.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,069.35
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
|
OP
|
$3,611.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.55 |
| Max. Negotiated Rate |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$722.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,108.60
|
| 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 HMO/PPO |
$3,721.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,520.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,303.82
|
| Rate for Payer: Cash Price |
$1,624.95
|
| Rate for Payer: Cash Price |
$1,624.95
|
| Rate for Payer: Cigna of CA HMO |
$2,311.04
|
| Rate for Payer: Cigna of CA PPO |
$2,672.14
|
| 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 |
$2,527.70
|
| 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 |
$3,069.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,166.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$224.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,292.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$866.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$2,888.80
|
| Rate for Payer: Networks By Design Commercial |
$2,347.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,069.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,166.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,166.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| 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 VENOGRAPHY AZYGOS HEMIAZYGOS VENOUS
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93585
|
| Hospital Charge Code |
906811585
|
|
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 |
$1,345.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| 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 VENOGRAPHY AZYGOS HEMIAZYGOS VENOUS
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93585
|
| Hospital Charge Code |
906811585
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$1,918.04
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| 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 VENOGRAPHY CONG HEART DEFECT
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93584
|
| Hospital Charge Code |
906811584
|
|
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 |
$1,345.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| 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 VENOGRAPHY CONG HEART DEFECT
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93584
|
| Hospital Charge Code |
906811584
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$65.92 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$1,918.04
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| 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 VENOGRAPHY CORONARY SINUS
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93586
|
| Hospital Charge Code |
906811586
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80.62 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$1,918.04
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| 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 VENOGRAPHY CORONARY SINUS
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93586
|
| Hospital Charge Code |
906811586
|
|
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 |
$1,345.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| 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 VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$177.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$753.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$487.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$665.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cigna of CA HMO |
$567.68
|
| Rate for Payer: Cigna of CA PPO |
$656.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$753.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$753.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$753.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$620.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$354.80
|
| Rate for Payer: Galaxy Health WC |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$563.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$523.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$620.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$620.90
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$443.50
|
| 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 |
$753.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$753.95
|
| Rate for Payer: Vantage Medical Group Senior |
$753.95
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$753.95 |
| Rate for Payer: Adventist Health Commercial |
$177.40
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$620.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$354.80
|
| Rate for Payer: Galaxy Health WC |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$563.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$523.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.88
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Adventist Health Commercial |
$109.20
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$382.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$218.40
|
| Rate for Payer: Galaxy Health WC |
$464.10
|
| Rate for Payer: Global Benefits Group Commercial |
$327.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$346.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$322.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.04
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Networks By Design Commercial |
$354.90
|
| Rate for Payer: Prime Health Services Commercial |
$464.10
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$464.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$409.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cigna of CA HMO |
$349.44
|
| Rate for Payer: Cigna of CA PPO |
$404.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$464.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$464.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$464.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$382.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$218.40
|
| Rate for Payer: Galaxy Health WC |
$464.10
|
| Rate for Payer: Global Benefits Group Commercial |
$327.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$190.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$346.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$322.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$382.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$382.20
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Networks By Design Commercial |
$354.90
|
| Rate for Payer: Prime Health Services Commercial |
$464.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$273.00
|
| 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 |
$464.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$464.10
|
| Rate for Payer: Vantage Medical Group Senior |
$464.10
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cigna of CA HMO |
$1,241.10
|
| Rate for Payer: Cigna of CA PPO |
$1,241.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,125.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,046.07
|
| 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 ACCESS PORT
|
Facility
|
OP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$1,507.05 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$975.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,329.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,073.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,363.44
|
| Rate for Payer: Blue Shield of California Commercial |
$898.91
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cigna of CA HMO |
$1,241.10
|
| Rate for Payer: Cigna of CA PPO |
$1,241.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,507.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,507.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,125.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$643.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,046.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,241.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,241.10
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$1,063.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,063.80
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,507.05
|
|
|
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 |
$217.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$307.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$285.56
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$307.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$216.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$285.56
|
| 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 |
$242.00
|
| 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 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 |
$4,027.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,264.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,682.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,279.91
|
| 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
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,789.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$4,027.05
|
| Rate for Payer: Cash Price |
$4,027.05
|
| Rate for Payer: Cash Price |
$4,027.05
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,264.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$7,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,369.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,310.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,682.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,874.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$4,474.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
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 |
$4,484.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,976.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,328.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,879.94
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,993.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$4,484.70
|
| Rate for Payer: Cash Price |
$4,484.70
|
| Rate for Payer: Cash Price |
$4,484.70
|
| 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 |
$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 |
$6,976.20
|
| 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 |
$8,471.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,979.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$746.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,328.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$844.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,391.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,983.00
|
| 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 |
$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 VENOUS PORT EXCHANGE
|
Facility
|
OP
|
$10,415.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$806.82 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Cigna of CA HMO |
$6,665.60
|
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 HMO/PPO |
$6,683.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cigna of CA PPO |
$7,707.10
|
| 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 |
$7,290.50
|
| 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 |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,613.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$5,207.50
|
| 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
|
|
