|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
|
OP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.58 |
| Max. Negotiated Rate |
$5,519.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$975.05
|
| 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 |
$3,271.14
|
| Rate for Payer: Blue Distinction Transplant |
$3,895.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,837.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,045.22
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cigna of CA HMO |
$4,155.52
|
| Rate for Payer: Cigna of CA PPO |
$4,804.82
|
| 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 |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,869.75
|
| 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 |
$4,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.32
|
| 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 |
$5,194.40
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,895.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,895.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: 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 VENOGRAM SUPERIOR VENACAVA
|
Facility
|
IP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,558.32 |
| Max. Negotiated Rate |
$5,519.05 |
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,597.20
|
| Rate for Payer: Galaxy Health WC |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,473.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.32
|
| Rate for Payer: Multiplan Commercial |
$5,194.40
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
|
IP
|
$4,248.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,019.52 |
| Max. Negotiated Rate |
$3,610.80 |
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,699.20
|
| Rate for Payer: Galaxy Health WC |
$3,610.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,548.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,833.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,618.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.52
|
| Rate for Payer: Multiplan Commercial |
$3,398.40
|
| Rate for Payer: Networks By Design Commercial |
$2,761.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,610.80
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
|
OP
|
$4,248.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$6,531.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$979.43
|
| 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 |
$3,289.19
|
| Rate for Payer: Blue Distinction Transplant |
$2,548.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,510.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,992.31
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cigna of CA HMO |
$2,718.72
|
| Rate for Payer: Cigna of CA PPO |
$3,143.52
|
| 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 |
$3,610.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,548.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,186.00
|
| 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 |
$2,833.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.52
|
| 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 |
$3,398.40
|
| Rate for Payer: Networks By Design Commercial |
$2,761.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,610.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,548.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,548.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: 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 VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.50 |
| 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 |
$770.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$498.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$544.20
|
| 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 |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.95
|
| Rate for Payer: Dignity Health Media |
$770.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$680.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| 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 |
$770.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.95
|
| Rate for Payer: Vantage Medical Group Senior |
$770.95
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.68 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.16 |
| 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 |
$475.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$307.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$335.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cigna of CA PPO |
$413.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.15
|
| Rate for Payer: Dignity Health Media |
$475.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$475.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$419.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.16
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$335.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$475.15
|
| Rate for Payer: Vantage Medical Group Senior |
$475.15
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.16 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.16
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.76 |
| Max. Negotiated Rate |
$509.15 |
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.76
|
| Rate for Payer: Multiplan Commercial |
$479.20
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.76 |
| 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 |
$509.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$329.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$329.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$359.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cigna of CA PPO |
$443.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.15
|
| Rate for Payer: Dignity Health Media |
$509.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$509.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$449.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.76
|
| Rate for Payer: Multiplan Commercial |
$479.20
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$359.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$509.15
|
| Rate for Payer: Vantage Medical Group Senior |
$509.15
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$11,083.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,659.92 |
| Max. Negotiated Rate |
$9,420.55 |
| Rate for Payer: Cash Price |
$4,987.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,433.20
|
| Rate for Payer: Galaxy Health WC |
$9,420.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,649.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,392.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,222.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,659.92
|
| Rate for Payer: Multiplan Commercial |
$8,866.40
|
| Rate for Payer: Networks By Design Commercial |
$7,203.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,420.55
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$11,083.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,659.92 |
| Max. Negotiated Rate |
$30,715.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,649.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$4,987.35
|
| Rate for Payer: Cash Price |
$4,987.35
|
| Rate for Payer: Cigna of CA PPO |
$8,201.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$9,420.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,649.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,312.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,392.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,874.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,659.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$8,866.40
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$7,203.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,420.55
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,649.80
|
| 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 |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
OP
|
$12,343.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$844.61 |
| Max. Negotiated Rate |
$30,715.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| 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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,405.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$5,554.35
|
| Rate for Payer: Cash Price |
$5,554.35
|
| Rate for Payer: Cigna of CA PPO |
$9,133.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$10,491.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,405.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,257.25
|
| 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 |
$8,232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,962.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$9,874.40
|
| Rate for Payer: Networks By Design Commercial |
$8,022.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,491.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,405.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
IP
|
$12,343.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,962.32 |
| Max. Negotiated Rate |
$10,491.55 |
| Rate for Payer: Cash Price |
$5,554.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,937.20
|
| Rate for Payer: Galaxy Health WC |
$10,491.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,405.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,702.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,962.32
|
| Rate for Payer: Multiplan Commercial |
$9,874.40
|
| Rate for Payer: Networks By Design Commercial |
$8,022.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,491.55
|
|
|
HC VENOUS SAMPLING
|
Facility
|
IP
|
$11,798.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,831.52 |
| Max. Negotiated Rate |
$10,028.30 |
| Rate for Payer: Cash Price |
$5,309.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,719.20
|
| Rate for Payer: Galaxy Health WC |
$10,028.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,078.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,869.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,495.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,831.52
|
| Rate for Payer: Multiplan Commercial |
$9,438.40
|
| Rate for Payer: Networks By Design Commercial |
$7,668.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,028.30
|
|
|
HC VENOUS SAMPLING
|
Facility
|
OP
|
$11,798.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$970.74 |
| Max. Negotiated Rate |
$11,260.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$970.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,271.01
|
| Rate for Payer: Blue Distinction Transplant |
$7,078.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,972.62
|
| Rate for Payer: Blue Shield of California EPN |
$5,533.26
|
| Rate for Payer: Cash Price |
$5,309.10
|
| Rate for Payer: Cash Price |
$5,309.10
|
| Rate for Payer: Cigna of CA HMO |
$7,550.72
|
| Rate for Payer: Cigna of CA PPO |
$8,730.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$10,028.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,078.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,848.50
|
| 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 |
$7,869.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,831.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$9,438.40
|
| Rate for Payer: Networks By Design Commercial |
$7,668.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,028.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,078.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,078.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$363.12 |
| Max. Negotiated Rate |
$1,286.05 |
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.12
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$179.21 |
| Max. Negotiated Rate |
$1,286.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$975.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$901.45
|
| Rate for Payer: Blue Distinction Transplant |
$907.80
|
| Rate for Payer: Blue Shield of California Commercial |
$894.18
|
| Rate for Payer: Blue Shield of California EPN |
$709.60
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cigna of CA HMO |
$968.32
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,134.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.46
|
| Rate for Payer: United Healthcare All Other HMO |
$396.46
|
| Rate for Payer: United Healthcare HMO Rider |
$396.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
OP
|
$9,607.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$85.12 |
| Max. Negotiated Rate |
$8,165.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$580.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,764.20
|
| 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 |
$4,323.15
|
| Rate for Payer: Cash Price |
$4,323.15
|
| Rate for Payer: Cash Price |
$4,323.15
|
| Rate for Payer: Cash Price |
$4,323.15
|
| Rate for Payer: Cigna of CA HMO |
$6,148.48
|
| Rate for Payer: Cigna of CA PPO |
$7,109.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Dignity Health Media |
$782.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$782.97
|
| Rate for Payer: Galaxy Health WC |
$8,165.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,764.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,205.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,284.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,284.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,268.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,268.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$782.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,407.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,305.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$986.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,049.18
|
| Rate for Payer: Multiplan Commercial |
$7,685.60
|
| Rate for Payer: Networks By Design Commercial |
$6,244.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,165.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,764.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,764.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
IP
|
$9,607.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,305.68 |
| Max. Negotiated Rate |
$8,165.95 |
| Rate for Payer: Cash Price |
$4,323.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,842.80
|
| Rate for Payer: Galaxy Health WC |
$8,165.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,764.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,407.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,660.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,305.68
|
| Rate for Payer: Multiplan Commercial |
$7,685.60
|
| Rate for Payer: Networks By Design Commercial |
$6,244.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,165.95
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
OP
|
$7,649.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.07 |
| Max. Negotiated Rate |
$6,501.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$419.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,589.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$3,442.05
|
| Rate for Payer: Cash Price |
$3,442.05
|
| Rate for Payer: Cash Price |
$3,442.05
|
| Rate for Payer: Cash Price |
$3,442.05
|
| Rate for Payer: Cigna of CA HMO |
$4,895.36
|
| Rate for Payer: Cigna of CA PPO |
$5,660.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Dignity Health Media |
$782.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$782.97
|
| Rate for Payer: Galaxy Health WC |
$6,501.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,589.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,736.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,284.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,284.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,268.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,268.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$782.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,835.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$986.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,049.18
|
| Rate for Payer: Multiplan Commercial |
$6,119.20
|
| Rate for Payer: Networks By Design Commercial |
$4,971.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,501.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,589.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,589.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
IP
|
$7,649.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,835.76 |
| Max. Negotiated Rate |
$6,501.65 |
| Rate for Payer: Cash Price |
$3,442.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,059.60
|
| Rate for Payer: Galaxy Health WC |
$6,501.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,589.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,914.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,835.76
|
| Rate for Payer: Multiplan Commercial |
$6,119.20
|
| Rate for Payer: Networks By Design Commercial |
$4,971.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,501.65
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| 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 |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna of CA PPO |
$2,037.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| 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 |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,377.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,377.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$660.96 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.60
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,049.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
|
|
HC VEP, CHECKERBOARD/FLASH
|
Facility
|
OP
|
$1,781.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$65.44 |
| Max. Negotiated Rate |
$1,513.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$795.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,061.12
|
| Rate for Payer: Blue Distinction Transplant |
$1,068.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,052.57
|
| Rate for Payer: Blue Shield of California EPN |
$835.29
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cigna of CA HMO |
$1,139.84
|
| Rate for Payer: Cigna of CA PPO |
$1,317.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,513.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,068.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,335.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,187.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,424.80
|
| Rate for Payer: Networks By Design Commercial |
$1,157.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,513.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,068.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,068.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
