|
HC APP SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$307.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$426.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO |
$454.40
|
| Rate for Payer: Cigna of CA PPO |
$525.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$532.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$644.40
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA PPO |
$794.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$805.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$859.20
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$644.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$537.00
|
| Rate for Payer: United Healthcare HMO Rider |
$537.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$537.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.76 |
| Max. Negotiated Rate |
$912.90 |
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.76
|
| Rate for Payer: Multiplan Commercial |
$859.20
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$322.32 |
| Max. Negotiated Rate |
$1,141.55 |
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.20
|
| Rate for Payer: Galaxy Health WC |
$1,141.55
|
| Rate for Payer: Global Benefits Group Commercial |
$805.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.32
|
| Rate for Payer: Multiplan Commercial |
$1,074.40
|
| Rate for Payer: Networks By Design Commercial |
$872.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,141.55
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$805.80
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Cash Price |
$604.35
|
| Rate for Payer: Cigna of CA PPO |
$993.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$1,141.55
|
| Rate for Payer: Global Benefits Group Commercial |
$805.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,007.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$1,074.40
|
| Rate for Payer: Networks By Design Commercial |
$872.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,141.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$805.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$671.50
|
| Rate for Payer: United Healthcare All Other HMO |
$671.50
|
| Rate for Payer: United Healthcare HMO Rider |
$671.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$671.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC APP SHORT LEG SPLINT
|
Facility
|
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$1,125.40 |
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
|
|
HC APP SHORT LEG SPLINT
|
Facility
|
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$794.40
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna of CA PPO |
$979.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$993.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$794.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$662.00
|
| Rate for Payer: United Healthcare All Other HMO |
$662.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$662.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.60
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$59.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cigna of CA HMO |
$63.36
|
| Rate for Payer: Cigna of CA PPO |
$73.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.15
|
| Rate for Payer: Dignity Health Media |
$84.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.60
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$74.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: Vantage Medical Group Senior |
$84.15
|
|
|
HC ARCH AORTA
|
Facility
|
OP
|
$9,643.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$330.33 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,785.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Cigna of CA PPO |
$7,135.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$8,196.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,785.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,232.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,431.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,714.40
|
| Rate for Payer: Networks By Design Commercial |
$6,267.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,196.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,785.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$9,643.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,314.32 |
| Max. Negotiated Rate |
$8,196.55 |
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,857.20
|
| Rate for Payer: Galaxy Health WC |
$8,196.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,431.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,673.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.32
|
| Rate for Payer: Multiplan Commercial |
$7,714.40
|
| Rate for Payer: Networks By Design Commercial |
$6,267.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,196.55
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.24 |
| Max. Negotiated Rate |
$659.60 |
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.24
|
| Rate for Payer: Multiplan Commercial |
$620.80
|
| Rate for Payer: Networks By Design Commercial |
$504.40
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$465.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA PPO |
$574.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$659.60
|
| Rate for Payer: Dignity Health Media |
$659.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$659.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$582.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.24
|
| Rate for Payer: Multiplan Commercial |
$620.80
|
| Rate for Payer: Networks By Design Commercial |
$504.40
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$659.60
|
| Rate for Payer: Vantage Medical Group Senior |
$659.60
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$1,725.50 |
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$812.00
|
| Rate for Payer: Galaxy Health WC |
$1,725.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,218.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,354.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$773.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.20
|
| Rate for Payer: Multiplan Commercial |
$1,624.00
|
| Rate for Payer: Networks By Design Commercial |
$1,319.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,725.50
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.36 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,725.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,116.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,116.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,218.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cigna of CA PPO |
$1,502.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,725.50
|
| Rate for Payer: Dignity Health Media |
$1,725.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,725.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$812.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$812.00
|
| Rate for Payer: Galaxy Health WC |
$1,725.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,218.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,522.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,354.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.20
|
| Rate for Payer: Multiplan Commercial |
$1,624.00
|
| Rate for Payer: Networks By Design Commercial |
$1,319.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,725.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,218.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,725.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,725.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,725.50
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$874.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$565.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$617.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cigna of CA PPO |
$761.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$874.65
|
| Rate for Payer: Dignity Health Media |
$874.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$411.60
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$771.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$686.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.96
|
| Rate for Payer: Multiplan Commercial |
$823.20
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$617.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$874.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.65
|
| Rate for Payer: Vantage Medical Group Senior |
$874.65
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.96 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.60
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$686.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.96
|
| Rate for Payer: Multiplan Commercial |
$823.20
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.44 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$940.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$608.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$663.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$818.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$940.10
|
| Rate for Payer: Dignity Health Media |
$940.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$940.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$442.40
|
| Rate for Payer: Galaxy Health WC |
$940.10
|
| Rate for Payer: Global Benefits Group Commercial |
$663.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$829.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.44
|
| Rate for Payer: Multiplan Commercial |
$884.80
|
| Rate for Payer: Networks By Design Commercial |
$718.90
|
| Rate for Payer: Prime Health Services Commercial |
$940.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$940.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$940.10
|
| Rate for Payer: Vantage Medical Group Senior |
$940.10
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.44 |
| Max. Negotiated Rate |
$940.10 |
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.40
|
| Rate for Payer: Galaxy Health WC |
$940.10
|
| Rate for Payer: Global Benefits Group Commercial |
$663.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.44
|
| Rate for Payer: Multiplan Commercial |
$884.80
|
| Rate for Payer: Networks By Design Commercial |
$718.90
|
| Rate for Payer: Prime Health Services Commercial |
$940.10
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$648.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cigna of CA PPO |
$799.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.85
|
| Rate for Payer: Dignity Health Media |
$918.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$810.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.44
|
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$918.85
|
| Rate for Payer: Vantage Medical Group Senior |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.44 |
| Max. Negotiated Rate |
$918.85 |
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.44
|
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.44 |
| Max. Negotiated Rate |
$918.85 |
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.44
|
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$648.60
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cigna of CA PPO |
$799.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.85
|
| Rate for Payer: Dignity Health Media |
$918.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$810.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.44
|
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.50
|
| Rate for Payer: United Healthcare All Other HMO |
$540.50
|
| Rate for Payer: United Healthcare HMO Rider |
$540.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$540.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$918.85
|
| Rate for Payer: Vantage Medical Group Senior |
$918.85
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
OP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$245.76 |
| Max. Negotiated Rate |
$11,260.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,111.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.19
|
| Rate for Payer: Blue Distinction Transplant |
$7,107.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,000.40
|
| Rate for Payer: Blue Shield of California EPN |
$5,555.30
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Cigna of CA HMO |
$7,580.80
|
| Rate for Payer: Cigna of CA PPO |
$8,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$10,068.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,107.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,883.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,900.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,842.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$9,476.00
|
| Rate for Payer: Networks By Design Commercial |
$7,699.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,068.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,107.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,107.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
IP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,842.80 |
| Max. Negotiated Rate |
$10,068.25 |
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,738.00
|
| Rate for Payer: Galaxy Health WC |
$10,068.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,107.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,900.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,512.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,842.80
|
| Rate for Payer: Multiplan Commercial |
$9,476.00
|
| Rate for Payer: Networks By Design Commercial |
$7,699.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,068.25
|
|
