|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,012.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,012.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,000.62
|
| Rate for Payer: Blue Shield of California EPN |
$660.54
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.50
|
| Rate for Payer: United Healthcare All Other HMO |
$817.50
|
| Rate for Payer: United Healthcare HMO Rider |
$817.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$817.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$380.66
|
| Rate for Payer: Blue Shield of California EPN |
$251.29
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cigna of CA HMO |
$398.08
|
| Rate for Payer: Cigna of CA PPO |
$460.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$482.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$373.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$373.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$311.00
|
| Rate for Payer: United Healthcare All Other HMO |
$311.00
|
| Rate for Payer: United Healthcare HMO Rider |
$311.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$311.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906820129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$387.20
|
| Rate for Payer: Cigna of CA PPO |
$447.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$482.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906820129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cigna of CA HMO |
$398.08
|
| Rate for Payer: Cigna of CA PPO |
$460.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$482.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$373.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC INNER CANNULA
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC INNER CANNULA
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.74
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
OP
|
$12,805.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
906820223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.69 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,561.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$5,762.25
|
| Rate for Payer: Cash Price |
$5,762.25
|
| Rate for Payer: Cash Price |
$5,762.25
|
| Rate for Payer: Cigna of CA HMO |
$8,195.20
|
| Rate for Payer: Cigna of CA PPO |
$9,475.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,884.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,683.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$429.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,540.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,073.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,244.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,323.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,884.25
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,683.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
IP
|
$12,805.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
906820223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,561.00 |
| Max. Negotiated Rate |
$10,884.25 |
| Rate for Payer: Adventist Health Commercial |
$2,561.00
|
| Rate for Payer: Cash Price |
$5,762.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,122.00
|
| Rate for Payer: Galaxy Health WC |
$10,884.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,683.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,540.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,878.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,926.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,073.20
|
| Rate for Payer: Multiplan Commercial |
$10,244.00
|
| Rate for Payer: Networks By Design Commercial |
$8,323.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,884.25
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
OP
|
$9,465.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.69 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,893.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$4,259.25
|
| Rate for Payer: Cash Price |
$4,259.25
|
| Rate for Payer: Cash Price |
$4,259.25
|
| Rate for Payer: Cigna of CA HMO |
$6,057.60
|
| Rate for Payer: Cigna of CA PPO |
$7,004.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,045.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,679.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$429.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,271.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,572.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,152.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,045.25
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,679.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
IP
|
$9,465.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,893.00 |
| Max. Negotiated Rate |
$8,045.25 |
| Rate for Payer: Adventist Health Commercial |
$1,893.00
|
| Rate for Payer: Cash Price |
$4,259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,786.00
|
| Rate for Payer: Galaxy Health WC |
$8,045.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,679.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,606.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,858.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,271.60
|
| Rate for Payer: Multiplan Commercial |
$7,572.00
|
| Rate for Payer: Networks By Design Commercial |
$6,152.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,045.25
|
|
|
HC INSERT BRONCHIAL VALVE
|
Facility
|
OP
|
$6,786.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.85 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,357.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,053.70
|
| Rate for Payer: Cash Price |
$3,053.70
|
| Rate for Payer: Cash Price |
$3,053.70
|
| Rate for Payer: Cigna of CA HMO |
$4,343.04
|
| Rate for Payer: Cigna of CA PPO |
$5,021.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,874.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8,795.69
|
| Rate for Payer: Galaxy Health WC |
$5,768.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,071.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,424.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$310.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,526.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,795.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,628.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,786.22
|
| Rate for Payer: Multiplan Commercial |
$5,428.80
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: Networks By Design Commercial |
$4,410.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,768.10
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,071.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,795.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
HC INSERT BRONCHIAL VALVE
|
Facility
|
IP
|
$6,786.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,357.20 |
| Max. Negotiated Rate |
$5,768.10 |
| Rate for Payer: Adventist Health Commercial |
$1,357.20
|
| Rate for Payer: Cash Price |
$3,053.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,714.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.40
|
| Rate for Payer: Galaxy Health WC |
$5,768.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,071.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,526.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,585.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,200.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,628.64
|
| Rate for Payer: Multiplan Commercial |
$5,428.80
|
| Rate for Payer: Networks By Design Commercial |
$4,410.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,768.10
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
IP
|
$3,958.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$791.60 |
| Max. Negotiated Rate |
$3,364.30 |
| Rate for Payer: Adventist Health Commercial |
$791.60
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,583.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,583.20
|
| Rate for Payer: Galaxy Health WC |
$3,364.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,639.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,508.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.92
|
| Rate for Payer: Multiplan Commercial |
$3,166.40
|
| Rate for Payer: Networks By Design Commercial |
$2,572.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,364.30
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
OP
|
$3,958.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$609.82 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$791.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cigna of CA HMO |
$2,533.12
|
| Rate for Payer: Cigna of CA PPO |
$2,928.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$3,364.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$609.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,639.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$689.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,166.40
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,572.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,364.30
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,374.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
IP
|
$2,245.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$1,908.25 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$898.00
|
| Rate for Payer: EPIC Health Plan Senior |
$898.00
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,497.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$855.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,389.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.80
|
| Rate for Payer: Multiplan Commercial |
$1,796.00
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,908.25
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
OP
|
$2,245.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cigna of CA HMO |
$1,436.80
|
| Rate for Payer: Cigna of CA PPO |
$1,661.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,497.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$1,796.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,908.25
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,347.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
909001904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$324.70 |
| Rate for Payer: Adventist Health Commercial |
$76.40
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$152.80
|
| Rate for Payer: Galaxy Health WC |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.68
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Networks By Design Commercial |
$248.30
|
| Rate for Payer: Prime Health Services Commercial |
$324.70
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906811389
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$235.52
|
| Rate for Payer: Cigna of CA PPO |
$272.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.00
|
| Rate for Payer: United Healthcare All Other HMO |
$184.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906820132
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: EPIC Health Plan Senior |
$138.00
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
