|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.04 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$586.80
|
| 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 |
$440.10
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna of CA PPO |
$723.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$733.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.80
|
| 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 |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.72 |
| Max. Negotiated Rate |
$831.30 |
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.20
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
IP
|
$4,999.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,199.76 |
| Max. Negotiated Rate |
$4,249.15 |
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,999.60
|
| Rate for Payer: Galaxy Health WC |
$4,249.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,999.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,334.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,904.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.76
|
| Rate for Payer: Multiplan Commercial |
$3,999.20
|
| Rate for Payer: Networks By Design Commercial |
$3,249.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,249.15
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
OP
|
$4,999.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| 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 |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,999.40
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cigna of CA PPO |
$3,699.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$4,249.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,999.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,749.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,872.77
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,872.77
|
| 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 |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,334.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$3,999.20
|
| Rate for Payer: Networks By Design Commercial |
$3,249.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,249.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,999.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,499.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,499.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.00 |
| 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 |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,039.20
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna of CA PPO |
$1,281.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,299.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,385.60
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.20
|
| 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 |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| 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 |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,039.20
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna of CA PPO |
$1,281.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,299.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| 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 |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,385.60
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$866.00
|
| Rate for Payer: United Healthcare HMO Rider |
$866.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$1,472.20 |
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.80
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.68
|
| Rate for Payer: Multiplan Commercial |
$1,385.60
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$1,472.20 |
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.80
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.68
|
| Rate for Payer: Multiplan Commercial |
$1,385.60
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,673.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.82 |
| 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 |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,003.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cigna of CA PPO |
$1,238.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,422.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,254.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,087.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,003.80
|
| 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 |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,673.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.52 |
| Max. Negotiated Rate |
$1,422.05 |
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.20
|
| Rate for Payer: Galaxy Health WC |
$1,422.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.52
|
| Rate for Payer: Multiplan Commercial |
$1,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,087.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.05
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,673.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.82 |
| 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 |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,003.80
|
| Rate for Payer: Blue Shield of California Commercial |
$988.74
|
| Rate for Payer: Blue Shield of California EPN |
$784.64
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cigna of CA HMO |
$1,070.72
|
| Rate for Payer: Cigna of CA PPO |
$1,238.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,422.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,254.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,087.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,003.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,003.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$836.50
|
| Rate for Payer: United Healthcare All Other HMO |
$836.50
|
| Rate for Payer: United Healthcare HMO Rider |
$836.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$836.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,673.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$401.52 |
| Max. Negotiated Rate |
$1,422.05 |
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.20
|
| Rate for Payer: Galaxy Health WC |
$1,422.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.52
|
| Rate for Payer: Multiplan Commercial |
$1,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,087.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.05
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$541.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$350.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$350.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.20
|
| Rate for Payer: Blue Shield of California Commercial |
$376.47
|
| Rate for Payer: Blue Shield of California EPN |
$298.75
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cigna of CA HMO |
$407.68
|
| Rate for Payer: Cigna of CA PPO |
$471.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$541.45
|
| Rate for Payer: Dignity Health Media |
$541.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$541.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$254.80
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$477.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$382.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.50
|
| Rate for Payer: United Healthcare All Other HMO |
$318.50
|
| Rate for Payer: United Healthcare HMO Rider |
$318.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$541.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$541.45
|
| Rate for Payer: Vantage Medical Group Senior |
$541.45
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.88 |
| 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 |
$541.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$350.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$350.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.20
|
| 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 |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cigna of CA PPO |
$471.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$541.45
|
| Rate for Payer: Dignity Health Media |
$541.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$541.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$254.80
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$477.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.20
|
| 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 |
$541.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$541.45
|
| Rate for Payer: Vantage Medical Group Senior |
$541.45
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
IP
|
$11,135.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,672.40 |
| Max. Negotiated Rate |
$9,464.75 |
| Rate for Payer: Cash Price |
$5,010.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,454.00
|
| Rate for Payer: Galaxy Health WC |
$9,464.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,681.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,427.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,242.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,672.40
|
| Rate for Payer: Multiplan Commercial |
$8,908.00
|
| Rate for Payer: Networks By Design Commercial |
$7,237.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,464.75
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
OP
|
$11,135.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$485.96 |
| 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 |
$6,681.00
|
| 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 |
$5,010.75
|
| Rate for Payer: Cash Price |
$5,010.75
|
| Rate for Payer: Cigna of CA PPO |
$8,239.90
|
| 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 |
$9,464.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,681.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,351.25
|
| 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 |
$7,427.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,672.40
|
| 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 |
$8,908.00
|
| Rate for Payer: Networks By Design Commercial |
$7,237.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,464.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,681.00
|
| 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 INSERT BRONCHIAL VALVE
|
Facility
|
IP
|
$8,404.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,016.96 |
| Max. Negotiated Rate |
$7,143.40 |
| Rate for Payer: Cash Price |
$3,781.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,361.60
|
| Rate for Payer: Galaxy Health WC |
$7,143.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,042.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,605.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,201.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,016.96
|
| Rate for Payer: Multiplan Commercial |
$6,723.20
|
| Rate for Payer: Networks By Design Commercial |
$5,462.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,143.40
|
|
|
HC INSERT BRONCHIAL VALVE
|
Facility
|
OP
|
$8,404.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$351.56 |
| 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 |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,042.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$3,781.80
|
| Rate for Payer: Cash Price |
$3,781.80
|
| Rate for Payer: Cigna of CA PPO |
$6,218.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Media |
$8,551.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,544.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,551.50
|
| Rate for Payer: Galaxy Health WC |
$7,143.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,042.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,303.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,024.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,024.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,853.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13,853.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,605.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,016.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan Commercial |
$6,723.20
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Networks By Design Commercial |
$5,462.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,143.40
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,042.40
|
| 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 |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
IP
|
$4,049.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$971.76 |
| Max. Negotiated Rate |
$3,441.65 |
| Rate for Payer: Cash Price |
$1,822.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.60
|
| Rate for Payer: Galaxy Health WC |
$3,441.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,429.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,700.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,542.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.76
|
| Rate for Payer: Multiplan Commercial |
$3,239.20
|
| Rate for Payer: Networks By Design Commercial |
$2,631.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,441.65
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
OP
|
$4,049.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.68 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,429.40
|
| 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 |
$1,822.05
|
| Rate for Payer: Cash Price |
$1,822.05
|
| Rate for Payer: Cigna of CA PPO |
$2,996.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$3,441.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,429.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,036.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,700.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$689.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$3,239.20
|
| Rate for Payer: Networks By Design Commercial |
$2,631.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,441.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,429.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$551.28 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,378.20
|
| 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 |
$1,033.65
|
| Rate for Payer: Cash Price |
$1,033.65
|
| Rate for Payer: Cigna of CA PPO |
$1,699.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$1,952.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,378.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,722.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$1,837.60
|
| Rate for Payer: Networks By Design Commercial |
$1,493.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,952.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,378.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$551.28 |
| Max. Negotiated Rate |
$1,952.45 |
| Rate for Payer: Cash Price |
$1,033.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.80
|
| Rate for Payer: Galaxy Health WC |
$1,952.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,378.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$875.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.28
|
| Rate for Payer: Multiplan Commercial |
$1,837.60
|
| Rate for Payer: Networks By Design Commercial |
$1,493.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,952.45
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906811389
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$84.24 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.40
|
| Rate for Payer: Galaxy Health WC |
$298.35
|
| Rate for Payer: Global Benefits Group Commercial |
$210.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.24
|
| Rate for Payer: Multiplan Commercial |
$280.80
|
| Rate for Payer: Networks By Design Commercial |
$228.15
|
| Rate for Payer: Prime Health Services Commercial |
$298.35
|
|
