|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$144.00
|
| 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 |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$153.60
|
| Rate for Payer: Cigna of CA PPO |
$177.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Media |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.00
|
| 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 |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$144.00
|
| 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 |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$153.60
|
| Rate for Payer: Cigna of CA PPO |
$177.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Media |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.00
|
| 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 |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
|
|
HC PHYSICIAN CONF PARTICIP 30 MIN
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 99367
|
| Hospital Charge Code |
908600144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.28
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
|
|
HC PHYSICIAN CONF PARTICIP 30 MIN
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 99367
|
| Hospital Charge Code |
908600144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$325.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$325.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.79
|
| Rate for Payer: Blue Distinction Transplant |
$58.20
|
| Rate for Payer: Blue Shield of California Commercial |
$71.49
|
| Rate for Payer: Blue Shield of California EPN |
$56.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cigna of CA HMO |
$62.08
|
| Rate for Payer: Cigna of CA PPO |
$71.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.45
|
| Rate for Payer: Dignity Health Media |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.28
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.50
|
| Rate for Payer: United Healthcare All Other HMO |
$48.50
|
| Rate for Payer: United Healthcare HMO Rider |
$48.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.45
|
| Rate for Payer: Vantage Medical Group Senior |
$82.45
|
|
|
HC PHYSICIAN CONF PARTICIP 30 MIN
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 99367
|
| Hospital Charge Code |
908600144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.28
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
|
|
HC PHYSICIAN CONF PARTICIP 30 MIN
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 99367
|
| Hospital Charge Code |
908600144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$325.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$325.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.79
|
| Rate for Payer: Blue Distinction Transplant |
$58.20
|
| Rate for Payer: Blue Shield of California Commercial |
$71.49
|
| Rate for Payer: Blue Shield of California EPN |
$56.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cigna of CA HMO |
$62.08
|
| Rate for Payer: Cigna of CA PPO |
$71.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.45
|
| Rate for Payer: Dignity Health Media |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.28
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.50
|
| Rate for Payer: United Healthcare All Other HMO |
$48.50
|
| Rate for Payer: United Healthcare HMO Rider |
$48.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.45
|
| Rate for Payer: Vantage Medical Group Senior |
$82.45
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$216.72 |
| Max. Negotiated Rate |
$767.55 |
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.20
|
| Rate for Payer: Galaxy Health WC |
$767.55
|
| Rate for Payer: Global Benefits Group Commercial |
$541.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.72
|
| Rate for Payer: Multiplan Commercial |
$722.40
|
| Rate for Payer: Networks By Design Commercial |
$586.95
|
| Rate for Payer: Prime Health Services Commercial |
$767.55
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$216.72 |
| Max. Negotiated Rate |
$1,834.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,081.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$767.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$496.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$496.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.01
|
| Rate for Payer: Blue Distinction Transplant |
$541.80
|
| 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 |
$406.35
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cigna of CA PPO |
$668.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$767.55
|
| Rate for Payer: Dignity Health Media |
$767.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$767.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.20
|
| Rate for Payer: Galaxy Health WC |
$767.55
|
| Rate for Payer: Global Benefits Group Commercial |
$541.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$677.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.72
|
| Rate for Payer: Multiplan Commercial |
$722.40
|
| Rate for Payer: Networks By Design Commercial |
$586.95
|
| Rate for Payer: Prime Health Services Commercial |
$767.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$541.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| 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 |
$767.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$767.55
|
| Rate for Payer: Vantage Medical Group Senior |
$767.55
|
|
|
HC PICC CATH KIT 3FR SL 55CM
|
Facility
|
OP
|
$901.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.38 |
| Max. Negotiated Rate |
$766.36 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$766.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.70
|
| Rate for Payer: Blue Distinction Transplant |
$540.96
|
| Rate for Payer: Blue Shield of California Commercial |
$641.94
|
| Rate for Payer: Blue Shield of California EPN |
$461.62
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Cigna of CA HMO |
$631.12
|
| Rate for Payer: Cigna of CA PPO |
$631.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$766.36
|
| Rate for Payer: Dignity Health Media |
$766.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.64
|
| Rate for Payer: Galaxy Health WC |
$766.36
|
| Rate for Payer: Global Benefits Group Commercial |
$540.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$676.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$601.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.38
|
| Rate for Payer: Multiplan Commercial |
$721.28
|
| Rate for Payer: Networks By Design Commercial |
$450.80
|
| Rate for Payer: Prime Health Services Commercial |
$766.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.80
|
| Rate for Payer: United Healthcare All Other HMO |
$450.80
|
| Rate for Payer: United Healthcare HMO Rider |
$450.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$766.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.36
|
| Rate for Payer: Vantage Medical Group Senior |
$766.36
|
|
|
HC PICC CATH KIT 3FR SL 55CM
|
Facility
|
IP
|
$901.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.38 |
| Max. Negotiated Rate |
$12,398.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,398.00
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Cigna of CA HMO |
$631.12
|
| Rate for Payer: Cigna of CA PPO |
$631.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.64
|
| Rate for Payer: Galaxy Health WC |
$766.36
|
| Rate for Payer: Global Benefits Group Commercial |
$540.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$601.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.38
|
| Rate for Payer: Multiplan Commercial |
$721.28
|
| Rate for Payer: Prime Health Services Commercial |
$766.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.44
|
| Rate for Payer: United Healthcare All Other HMO |
$332.51
|
| Rate for Payer: United Healthcare HMO Rider |
$325.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.53
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$5,835.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.29 |
| 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 |
$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 |
$3,501.00
|
| 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 |
$2,625.75
|
| Rate for Payer: Cash Price |
$2,625.75
|
| Rate for Payer: Cigna of CA PPO |
$4,317.90
|
| 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 |
$4,959.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,501.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,376.25
|
| 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 |
$3,891.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,400.40
|
| 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 |
$4,668.00
|
| Rate for Payer: Networks By Design Commercial |
$3,792.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,959.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,501.00
|
| 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 |
$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 PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$5,835.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,400.40 |
| Max. Negotiated Rate |
$4,959.75 |
| Rate for Payer: Cash Price |
$2,625.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,334.00
|
| Rate for Payer: Galaxy Health WC |
$4,959.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,501.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,891.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,223.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,400.40
|
| Rate for Payer: Multiplan Commercial |
$4,668.00
|
| Rate for Payer: Networks By Design Commercial |
$3,792.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,959.75
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$5,835.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.29 |
| 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 |
$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 |
$3,501.00
|
| Rate for Payer: Cash Price |
$2,625.75
|
| Rate for Payer: Cash Price |
$2,625.75
|
| Rate for Payer: Cash Price |
$2,625.75
|
| Rate for Payer: Cigna of CA PPO |
$4,317.90
|
| 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 |
$4,959.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,501.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,376.25
|
| 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 |
$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 |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,891.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,400.40
|
| 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 |
$4,668.00
|
| Rate for Payer: Networks By Design Commercial |
$3,792.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,959.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,501.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,917.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,917.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,917.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,917.50
|
| 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 PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$5,835.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,400.40 |
| Max. Negotiated Rate |
$4,959.75 |
| Rate for Payer: Cash Price |
$2,625.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,334.00
|
| Rate for Payer: Galaxy Health WC |
$4,959.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,501.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,891.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,223.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,400.40
|
| Rate for Payer: Multiplan Commercial |
$4,668.00
|
| Rate for Payer: Networks By Design Commercial |
$3,792.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,959.75
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
OP
|
$5,605.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.26 |
| 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 |
$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 |
$3,363.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,312.56
|
| Rate for Payer: Blue Shield of California EPN |
$2,628.74
|
| Rate for Payer: Cash Price |
$2,522.25
|
| Rate for Payer: Cash Price |
$2,522.25
|
| Rate for Payer: Cigna of CA HMO |
$3,587.20
|
| Rate for Payer: Cigna of CA PPO |
$4,147.70
|
| 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 |
$4,764.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,363.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,203.75
|
| 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 |
$3,738.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.20
|
| 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 |
$4,484.00
|
| Rate for Payer: Networks By Design Commercial |
$3,643.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,764.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,802.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,802.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,802.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,802.50
|
| 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 PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
IP
|
$5,605.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,345.20 |
| Max. Negotiated Rate |
$4,764.25 |
| Rate for Payer: Cash Price |
$2,522.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,242.00
|
| Rate for Payer: Galaxy Health WC |
$4,764.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,363.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,738.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,135.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.20
|
| Rate for Payer: Multiplan Commercial |
$4,484.00
|
| Rate for Payer: Networks By Design Commercial |
$3,643.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,764.25
|
|
|
HC PICU BACK TRANSPORT PER HOUR
|
Facility
|
IP
|
$3,587.00
|
|
| Hospital Charge Code |
905200103
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: Cash Price |
$1,614.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,434.80
|
| Rate for Payer: Galaxy Health WC |
$3,048.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,152.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,392.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,366.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$860.88
|
| Rate for Payer: Multiplan Commercial |
$2,869.60
|
| Rate for Payer: Networks By Design Commercial |
$2,331.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,048.95
|
|
|
HC PICU TRANSPORT CASE RATE
|
Facility
|
IP
|
$2,068.00
|
|
| Hospital Charge Code |
905200104
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$827.20
|
| Rate for Payer: Galaxy Health WC |
$1,757.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,240.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,379.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$787.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.32
|
| Rate for Payer: Multiplan Commercial |
$1,654.40
|
| Rate for Payer: Networks By Design Commercial |
$1,344.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,757.80
|
|
|
HC PICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$2,985.00
|
|
| Hospital Charge Code |
905200100
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$1,343.25
|
| Rate for Payer: Cash Price |
$1,343.25
|
| Rate for Payer: Cash Price |
$1,343.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,194.00
|
| Rate for Payer: Galaxy Health WC |
$2,537.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,791.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,991.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,137.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.40
|
| Rate for Payer: Multiplan Commercial |
$2,388.00
|
| Rate for Payer: Networks By Design Commercial |
$1,940.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,537.25
|
|
|
HC PIN WORM PREP
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$38.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.94
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.58
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11.63
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$14,490.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.91 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,694.00
|
| 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 |
$6,520.50
|
| Rate for Payer: Cash Price |
$6,520.50
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| 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 |
$12,316.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,694.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,867.50
|
| 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 |
$9,664.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,477.60
|
| 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 |
$11,592.00
|
| Rate for Payer: Networks By Design Commercial |
$9,418.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,316.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,694.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| 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 PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$14,490.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,477.60 |
| Max. Negotiated Rate |
$12,316.50 |
| Rate for Payer: Cash Price |
$6,520.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,796.00
|
| Rate for Payer: Galaxy Health WC |
$12,316.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,694.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,664.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,520.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,477.60
|
| Rate for Payer: Multiplan Commercial |
$11,592.00
|
| Rate for Payer: Networks By Design Commercial |
$9,418.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,316.50
|
|
