|
HC ARCH AORTA
|
Facility
|
OP
|
$8,197.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.08 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Adventist Health Commercial |
$1,639.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,688.65
|
| Rate for Payer: Cash Price |
$3,688.65
|
| Rate for Payer: Cash Price |
$3,688.65
|
| Rate for Payer: Cigna of CA HMO |
$5,246.08
|
| Rate for Payer: Cigna of CA PPO |
$6,065.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,967.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,918.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$6,557.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$5,328.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,967.45
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,918.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
IP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cigna of CA HMO |
$1,979.25
|
| Rate for Payer: Cigna of CA PPO |
$1,979.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.00
|
| Rate for Payer: Galaxy Health WC |
$2,403.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,885.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.60
|
| Rate for Payer: Multiplan Commercial |
$2,262.00
|
| Rate for Payer: Networks By Design Commercial |
$1,413.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1,032.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.01
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
OP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$2,403.38 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,637.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,086.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,374.16
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cigna of CA HMO |
$1,979.25
|
| Rate for Payer: Cigna of CA PPO |
$1,979.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,403.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.00
|
| Rate for Payer: Galaxy Health WC |
$2,403.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,885.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,979.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,979.25
|
| Rate for Payer: Multiplan Commercial |
$2,262.00
|
| Rate for Payer: Networks By Design Commercial |
$1,413.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,696.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1,032.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.38
|
|
|
HC ARISTA HEMOSTAT
|
Facility
|
IP
|
$522.00
|
|
| Hospital Charge Code |
906812375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.28
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
|
|
HC ARISTA HEMOSTAT
|
Facility
|
OP
|
$522.00
|
|
| Hospital Charge Code |
906812375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.56
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna of CA HMO |
$334.08
|
| Rate for Payer: Cigna of CA PPO |
$386.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$443.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.70
|
| Rate for Payer: Vantage Medical Group Senior |
$443.70
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$561.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$363.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO |
$422.40
|
| Rate for Payer: Cigna of CA PPO |
$488.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$561.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$561.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Senior |
$264.00
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$440.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$408.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$462.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$462.00
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$561.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.00
|
| Rate for Payer: Vantage Medical Group Senior |
$561.00
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Senior |
$264.00
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$440.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$408.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
906820179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$758.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cigna of CA HMO |
$570.88
|
| Rate for Payer: Cigna of CA PPO |
$660.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$758.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$758.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Senior |
$356.80
|
| Rate for Payer: Galaxy Health WC |
$758.20
|
| Rate for Payer: Global Benefits Group Commercial |
$535.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$552.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$624.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$624.40
|
| Rate for Payer: Multiplan Commercial |
$713.60
|
| Rate for Payer: Networks By Design Commercial |
$579.80
|
| Rate for Payer: Prime Health Services Commercial |
$758.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$535.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$758.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.20
|
| Rate for Payer: Vantage Medical Group Senior |
$758.20
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
906820179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$758.20 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Senior |
$356.80
|
| Rate for Payer: Galaxy Health WC |
$758.20
|
| Rate for Payer: Global Benefits Group Commercial |
$535.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$552.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.08
|
| Rate for Payer: Multiplan Commercial |
$713.60
|
| Rate for Payer: Networks By Design Commercial |
$579.80
|
| Rate for Payer: Prime Health Services Commercial |
$758.20
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
IP
|
$2,334.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
906820176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$466.80 |
| Max. Negotiated Rate |
$1,983.90 |
| Rate for Payer: Adventist Health Commercial |
$466.80
|
| Rate for Payer: Cash Price |
$1,050.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$933.60
|
| Rate for Payer: EPIC Health Plan Senior |
$933.60
|
| Rate for Payer: Galaxy Health WC |
$1,983.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,400.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$889.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,444.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$560.16
|
| Rate for Payer: Multiplan Commercial |
$1,867.20
|
| Rate for Payer: Networks By Design Commercial |
$1,517.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,983.90
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
OP
|
$2,334.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
906820176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.72 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$466.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,983.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,750.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,050.30
|
| Rate for Payer: Cash Price |
$1,050.30
|
| Rate for Payer: Cash Price |
$1,050.30
|
| Rate for Payer: Cigna of CA HMO |
$1,493.76
|
| Rate for Payer: Cigna of CA PPO |
$1,727.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,983.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,983.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,983.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$933.60
|
| Rate for Payer: EPIC Health Plan Senior |
$933.60
|
| Rate for Payer: Galaxy Health WC |
$1,983.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,400.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,444.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$560.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,633.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,633.80
|
| Rate for Payer: Multiplan Commercial |
$1,867.20
|
| Rate for Payer: Networks By Design Commercial |
$1,517.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,983.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,400.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,983.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,983.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,983.90
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
OP
|
$1,726.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.72 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$345.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,467.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$949.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,294.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna of CA HMO |
$1,104.64
|
| Rate for Payer: Cigna of CA PPO |
$1,277.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,467.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,467.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,467.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.40
|
| Rate for Payer: EPIC Health Plan Senior |
$690.40
|
| Rate for Payer: Galaxy Health WC |
$1,467.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,151.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,068.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,208.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,208.20
|
| Rate for Payer: Multiplan Commercial |
$1,380.80
|
| Rate for Payer: Networks By Design Commercial |
$1,121.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,467.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,035.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,467.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,467.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,467.10
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
IP
|
$1,726.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.20 |
| Max. Negotiated Rate |
$1,467.10 |
| Rate for Payer: Adventist Health Commercial |
$345.20
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.40
|
| Rate for Payer: EPIC Health Plan Senior |
$690.40
|
| Rate for Payer: Galaxy Health WC |
$1,467.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,151.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$657.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,068.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.24
|
| Rate for Payer: Multiplan Commercial |
$1,380.80
|
| Rate for Payer: Networks By Design Commercial |
$1,121.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,467.10
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
906820177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$236.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,005.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$650.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$887.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cigna of CA HMO |
$757.12
|
| Rate for Payer: Cigna of CA PPO |
$875.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,005.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,005.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,005.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.20
|
| Rate for Payer: EPIC Health Plan Senior |
$473.20
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$732.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$828.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$828.10
|
| Rate for Payer: Multiplan Commercial |
$946.40
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$709.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,005.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,005.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,005.55
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO |
$560.00
|
| Rate for Payer: Cigna of CA PPO |
$647.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
906820177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Adventist Health Commercial |
$236.60
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.20
|
| Rate for Payer: EPIC Health Plan Senior |
$473.20
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$732.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.92
|
| Rate for Payer: Multiplan Commercial |
$946.40
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
IP
|
$1,272.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
906820178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.40 |
| Max. Negotiated Rate |
$1,081.20 |
| Rate for Payer: Adventist Health Commercial |
$254.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$508.80
|
| Rate for Payer: Galaxy Health WC |
$1,081.20
|
| Rate for Payer: Global Benefits Group Commercial |
$763.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$848.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$787.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.28
|
| Rate for Payer: Multiplan Commercial |
$1,017.60
|
| Rate for Payer: Networks By Design Commercial |
$826.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,081.20
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$799.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$517.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$705.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna of CA HMO |
$601.60
|
| Rate for Payer: Cigna of CA PPO |
$695.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$799.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$799.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$799.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.00
|
| Rate for Payer: EPIC Health Plan Senior |
$376.00
|
| Rate for Payer: Galaxy Health WC |
$799.00
|
| Rate for Payer: Global Benefits Group Commercial |
$564.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$441.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$581.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$658.00
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: Networks By Design Commercial |
$611.00
|
| Rate for Payer: Prime Health Services Commercial |
$799.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$799.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$799.00
|
| Rate for Payer: Vantage Medical Group Senior |
$799.00
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
OP
|
$1,272.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
906820178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.40 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$254.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,081.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$699.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$954.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna of CA HMO |
$814.08
|
| Rate for Payer: Cigna of CA PPO |
$941.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,081.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,081.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,081.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$508.80
|
| Rate for Payer: Galaxy Health WC |
$1,081.20
|
| Rate for Payer: Global Benefits Group Commercial |
$763.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$441.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$848.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$787.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$890.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$890.40
|
| Rate for Payer: Multiplan Commercial |
$1,017.60
|
| Rate for Payer: Networks By Design Commercial |
$826.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,081.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,081.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,081.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,081.20
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.00
|
| Rate for Payer: EPIC Health Plan Senior |
$376.00
|
| Rate for Payer: Galaxy Health WC |
$799.00
|
| Rate for Payer: Global Benefits Group Commercial |
$564.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$581.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: Networks By Design Commercial |
$611.00
|
| Rate for Payer: Prime Health Services Commercial |
$799.00
|
|
|
HC ARTERIAL CATHETERIZATION KIT
|
Facility
|
OP
|
$423.23
|
|
| Hospital Charge Code |
901698288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.65 |
| Max. Negotiated Rate |
$359.75 |
| Rate for Payer: Adventist Health Commercial |
$84.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$277.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.91
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Cigna of CA HMO |
$270.87
|
| Rate for Payer: Cigna of CA PPO |
$313.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.29
|
| Rate for Payer: EPIC Health Plan Senior |
$169.29
|
| Rate for Payer: Galaxy Health WC |
$359.75
|
| Rate for Payer: Global Benefits Group Commercial |
$253.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$296.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$296.26
|
| Rate for Payer: Multiplan Commercial |
$338.58
|
| Rate for Payer: Networks By Design Commercial |
$275.10
|
| Rate for Payer: Prime Health Services Commercial |
$359.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.62
|
| Rate for Payer: United Healthcare All Other HMO |
$211.62
|
| Rate for Payer: United Healthcare HMO Rider |
$211.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.75
|
| Rate for Payer: Vantage Medical Group Senior |
$359.75
|
|
|
HC ARTERIAL CATHETERIZATION KIT
|
Facility
|
IP
|
$423.23
|
|
| Hospital Charge Code |
901698288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.65 |
| Max. Negotiated Rate |
$359.75 |
| Rate for Payer: Adventist Health Commercial |
$84.65
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.29
|
| Rate for Payer: EPIC Health Plan Senior |
$169.29
|
| Rate for Payer: Galaxy Health WC |
$359.75
|
| Rate for Payer: Global Benefits Group Commercial |
$253.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.58
|
| Rate for Payer: Multiplan Commercial |
$338.58
|
| Rate for Payer: Networks By Design Commercial |
$275.10
|
| Rate for Payer: Prime Health Services Commercial |
$359.75
|
|
|
HC ARTERIAL LINE INSERTION KIT
|
Facility
|
IP
|
$111.68
|
|
| Hospital Charge Code |
901698279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$94.93 |
| Rate for Payer: Adventist Health Commercial |
$22.34
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.67
|
| Rate for Payer: EPIC Health Plan Senior |
$44.67
|
| Rate for Payer: Galaxy Health WC |
$94.93
|
| Rate for Payer: Global Benefits Group Commercial |
$67.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Multiplan Commercial |
$89.34
|
| Rate for Payer: Networks By Design Commercial |
$72.59
|
| Rate for Payer: Prime Health Services Commercial |
$94.93
|
|
|
HC ARTERIAL LINE INSERTION KIT
|
Facility
|
OP
|
$111.68
|
|
| Hospital Charge Code |
901698279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$94.93 |
| Rate for Payer: Adventist Health Commercial |
$22.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.58
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cigna of CA HMO |
$71.48
|
| Rate for Payer: Cigna of CA PPO |
$82.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.67
|
| Rate for Payer: EPIC Health Plan Senior |
$44.67
|
| Rate for Payer: Galaxy Health WC |
$94.93
|
| Rate for Payer: Global Benefits Group Commercial |
$67.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.18
|
| Rate for Payer: Multiplan Commercial |
$89.34
|
| Rate for Payer: Networks By Design Commercial |
$72.59
|
| Rate for Payer: Prime Health Services Commercial |
$94.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.84
|
| Rate for Payer: United Healthcare All Other HMO |
$55.84
|
| Rate for Payer: United Healthcare HMO Rider |
$55.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.93
|
| Rate for Payer: Vantage Medical Group Senior |
$94.93
|
|
