|
HC INSERT NON-TNEL CV CATH LT 5YR
|
Facility
|
OP
|
$3,868.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
906812249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$773.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,127.40
|
| Rate for Payer: Cash Price |
$2,127.40
|
| Rate for Payer: Cash Price |
$2,127.40
|
| Rate for Payer: Cigna of CA HMO |
$2,475.52
|
| Rate for Payer: Cigna of CA PPO |
$2,862.32
|
| 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 |
$3,287.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,320.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,579.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.32
|
| 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 |
$3,094.40
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$2,514.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,287.80
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,320.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,934.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,934.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,934.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,934.00
|
| 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 INSERT NON-TNNL CV CATH LT 5YR
|
Facility
|
OP
|
$3,868.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
909081358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.10 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$773.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$5,398.00
|
| 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 |
$2,127.40
|
| Rate for Payer: Cash Price |
$2,127.40
|
| Rate for Payer: Cash Price |
$2,127.40
|
| Rate for Payer: Cigna of CA HMO |
$2,475.52
|
| Rate for Payer: Cigna of CA PPO |
$2,862.32
|
| 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 |
$3,287.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,320.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,579.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.32
|
| 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 |
$3,094.40
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$2,514.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,287.80
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,320.80
|
| 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 |
$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 INSERT NON-TNNL CV CATH LT 5YR
|
Facility
|
IP
|
$3,868.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
909081358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.60 |
| Max. Negotiated Rate |
$3,287.80 |
| Rate for Payer: Adventist Health Commercial |
$773.60
|
| Rate for Payer: Cash Price |
$2,127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,547.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,547.20
|
| Rate for Payer: Galaxy Health WC |
$3,287.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,320.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,579.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,473.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,394.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.32
|
| Rate for Payer: Multiplan Commercial |
$3,094.40
|
| Rate for Payer: Networks By Design Commercial |
$2,514.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,287.80
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
OP
|
$5,612.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cigna of CA HMO |
$3,591.68
|
| Rate for Payer: Cigna of CA PPO |
$4,152.88
|
| 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 |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.88
|
| 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 |
$4,489.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,367.20
|
| 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 |
$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 INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
IP
|
$5,612.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,122.40 |
| Max. Negotiated Rate |
$4,770.20 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,244.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,244.80
|
| Rate for Payer: Galaxy Health WC |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,138.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,473.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$4,489.60
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
IP
|
$5,612.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,122.40 |
| Max. Negotiated Rate |
$4,770.20 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,244.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,244.80
|
| Rate for Payer: Galaxy Health WC |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,138.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,473.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$4,489.60
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
OP
|
$5,612.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cigna of CA HMO |
$3,591.68
|
| Rate for Payer: Cigna of CA PPO |
$4,152.88
|
| 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 |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.88
|
| 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 |
$4,489.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,367.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,806.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,806.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.00
|
| 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 INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
OP
|
$5,612.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
901200045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cigna of CA HMO |
$3,591.68
|
| Rate for Payer: Cigna of CA PPO |
$4,152.88
|
| 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 |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.88
|
| 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 |
$4,489.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,367.20
|
| 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 |
$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 INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
IP
|
$5,612.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
901200045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,122.40 |
| Max. Negotiated Rate |
$4,770.20 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,244.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,244.80
|
| Rate for Payer: Galaxy Health WC |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,138.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,473.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$4,489.60
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
IP
|
$6,602.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906820086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,320.40 |
| Max. Negotiated Rate |
$5,611.70 |
| Rate for Payer: Adventist Health Commercial |
$1,320.40
|
| Rate for Payer: Cash Price |
$3,631.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,640.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,640.80
|
| Rate for Payer: Galaxy Health WC |
$5,611.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,961.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,403.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,515.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.48
|
| Rate for Payer: Multiplan Commercial |
$5,281.60
|
| Rate for Payer: Networks By Design Commercial |
$4,291.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,611.70
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
OP
|
$6,602.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906820086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,320.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,631.10
|
| Rate for Payer: Cash Price |
$3,631.10
|
| Rate for Payer: Cash Price |
$3,631.10
|
| Rate for Payer: Cigna of CA HMO |
$4,225.28
|
| Rate for Payer: Cigna of CA PPO |
$4,885.48
|
| 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 |
$5,611.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,961.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,403.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.48
|
| 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 |
$5,281.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,291.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,611.70
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,961.20
|
| 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 |
$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 INSERT PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$31,505.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906811995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,301.00 |
| Max. Negotiated Rate |
$26,779.25 |
| Rate for Payer: Adventist Health Commercial |
$6,301.00
|
| Rate for Payer: Cash Price |
$17,327.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,602.00
|
| Rate for Payer: Galaxy Health WC |
$26,779.25
|
| Rate for Payer: Global Benefits Group Commercial |
$18,903.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,013.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,003.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,501.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,561.20
|
| Rate for Payer: Multiplan Commercial |
$25,204.00
|
| Rate for Payer: Networks By Design Commercial |
$20,478.25
|
| Rate for Payer: Prime Health Services Commercial |
$26,779.25
|
|
|
HC INSERT PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$31,505.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906811995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$507.26 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,301.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,779.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,327.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,628.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| 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 |
$17,327.75
|
| Rate for Payer: Cash Price |
$17,327.75
|
| Rate for Payer: Cash Price |
$17,327.75
|
| Rate for Payer: Cigna of CA HMO |
$20,163.20
|
| Rate for Payer: Cigna of CA PPO |
$23,313.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,779.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,779.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,779.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,602.00
|
| Rate for Payer: Galaxy Health WC |
$26,779.25
|
| Rate for Payer: Global Benefits Group Commercial |
$18,903.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$507.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,013.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,501.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,561.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,053.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,053.50
|
| Rate for Payer: Multiplan Commercial |
$25,204.00
|
| Rate for Payer: Networks By Design Commercial |
$20,478.25
|
| Rate for Payer: Prime Health Services Commercial |
$26,779.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,903.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$26,779.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,779.25
|
| Rate for Payer: Vantage Medical Group Senior |
$26,779.25
|
|
|
HC INSERT PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$30,619.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906820320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,123.80 |
| Max. Negotiated Rate |
$26,026.15 |
| Rate for Payer: Adventist Health Commercial |
$6,123.80
|
| Rate for Payer: Cash Price |
$16,840.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12,247.60
|
| Rate for Payer: Galaxy Health WC |
$26,026.15
|
| Rate for Payer: Global Benefits Group Commercial |
$18,371.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,422.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,665.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,953.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,348.56
|
| Rate for Payer: Multiplan Commercial |
$24,495.20
|
| Rate for Payer: Networks By Design Commercial |
$19,902.35
|
| Rate for Payer: Prime Health Services Commercial |
$26,026.15
|
|
|
HC INSERT PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$30,619.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906820320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$507.26 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,123.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,026.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,840.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,964.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| 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 |
$16,840.45
|
| Rate for Payer: Cash Price |
$16,840.45
|
| Rate for Payer: Cash Price |
$16,840.45
|
| Rate for Payer: Cigna of CA HMO |
$19,596.16
|
| Rate for Payer: Cigna of CA PPO |
$22,658.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,026.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,026.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,026.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12,247.60
|
| Rate for Payer: Galaxy Health WC |
$26,026.15
|
| Rate for Payer: Global Benefits Group Commercial |
$18,371.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$507.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,422.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,953.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,348.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,433.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,433.30
|
| Rate for Payer: Multiplan Commercial |
$24,495.20
|
| Rate for Payer: Networks By Design Commercial |
$19,902.35
|
| Rate for Payer: Prime Health Services Commercial |
$26,026.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,371.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$26,026.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,026.15
|
| Rate for Payer: Vantage Medical Group Senior |
$26,026.15
|
|
|
HC INSERT PERM INTRAPERITONEAL CATH/DIALYSIS
|
Facility
|
OP
|
$11,711.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
909000217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$327.75 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,342.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| 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 |
$6,441.05
|
| Rate for Payer: Cash Price |
$6,441.05
|
| Rate for Payer: Cash Price |
$6,441.05
|
| Rate for Payer: Cigna of CA HMO |
$7,495.04
|
| Rate for Payer: Cigna of CA PPO |
$8,666.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$9,954.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,026.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$327.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,811.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$9,368.80
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$7,612.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,954.35
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,026.60
|
| 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 |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC INSERT PERM INTRAPERITONEAL CATH/DIALYSIS
|
Facility
|
IP
|
$11,711.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
909000217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,342.20 |
| Max. Negotiated Rate |
$9,954.35 |
| Rate for Payer: Adventist Health Commercial |
$2,342.20
|
| Rate for Payer: Cash Price |
$6,441.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,684.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,684.40
|
| Rate for Payer: Galaxy Health WC |
$9,954.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,026.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,811.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,461.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,249.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.64
|
| Rate for Payer: Multiplan Commercial |
$9,368.80
|
| Rate for Payer: Networks By Design Commercial |
$7,612.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,954.35
|
|
|
HC INSERT PLEURAL CATH W CUFF
|
Facility
|
OP
|
$13,506.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
909020011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,006.99 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,701.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$7,428.30
|
| Rate for Payer: Cash Price |
$7,428.30
|
| Rate for Payer: Cash Price |
$7,428.30
|
| Rate for Payer: Cigna of CA HMO |
$8,643.84
|
| Rate for Payer: Cigna of CA PPO |
$9,994.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$11,480.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,103.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,006.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,241.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$10,804.80
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$8,778.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,480.10
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,103.60
|
| 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 |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC INSERT PLEURAL CATH W CUFF
|
Facility
|
IP
|
$13,506.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
909020011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,701.20 |
| Max. Negotiated Rate |
$11,480.10 |
| Rate for Payer: Adventist Health Commercial |
$2,701.20
|
| Rate for Payer: Cash Price |
$7,428.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,402.40
|
| Rate for Payer: Galaxy Health WC |
$11,480.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,103.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,145.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,360.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,241.44
|
| Rate for Payer: Multiplan Commercial |
$10,804.80
|
| Rate for Payer: Networks By Design Commercial |
$8,778.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,480.10
|
|
|
HC INSERT & REMOVE BONE PIN/WIRE
|
Facility
|
IP
|
$9,211.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
900501245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,842.20 |
| Max. Negotiated Rate |
$7,829.35 |
| Rate for Payer: Adventist Health Commercial |
$1,842.20
|
| Rate for Payer: Cash Price |
$5,066.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,684.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,684.40
|
| Rate for Payer: Galaxy Health WC |
$7,829.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,526.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,143.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,509.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,701.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.64
|
| Rate for Payer: Multiplan Commercial |
$7,368.80
|
| Rate for Payer: Networks By Design Commercial |
$5,987.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,829.35
|
|
|
HC INSERT & REMOVE BONE PIN/WIRE
|
Facility
|
OP
|
$9,211.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
900501245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.06 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,842.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$5,066.05
|
| Rate for Payer: Cash Price |
$5,066.05
|
| Rate for Payer: Cash Price |
$5,066.05
|
| Rate for Payer: Cigna of CA HMO |
$5,895.04
|
| Rate for Payer: Cigna of CA PPO |
$6,816.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$7,829.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,526.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,143.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$7,368.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,987.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,829.35
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,526.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,605.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,605.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,605.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,605.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC INSERT SUBQ DEFIB WELTRD
|
Facility
|
OP
|
$77,865.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
906811456
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$855.00 |
| Max. Negotiated Rate |
$109,559.00 |
| Rate for Payer: Adventist Health Commercial |
$15,573.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,737.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,133.00
|
| 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 |
$42,825.75
|
| Rate for Payer: Cash Price |
$42,825.75
|
| Rate for Payer: Cash Price |
$42,825.75
|
| Rate for Payer: Cigna of CA HMO |
$49,833.60
|
| Rate for Payer: Cigna of CA PPO |
$57,620.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,811.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,737.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,995.54
|
| Rate for Payer: EPIC Health Plan Senior |
$40,737.44
|
| Rate for Payer: Galaxy Health WC |
$66,185.25
|
| Rate for Payer: Global Benefits Group Commercial |
$46,719.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$66,809.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$855.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,737.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51,935.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$966.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,737.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,687.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,329.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,588.17
|
| Rate for Payer: Multiplan Commercial |
$62,292.00
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: Networks By Design Commercial |
$50,612.25
|
| Rate for Payer: Prime Health Services Commercial |
$66,185.25
|
| Rate for Payer: Prime Health Services WC |
$64,245.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46,719.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$109,559.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$40,737.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Vantage Medical Group Senior |
$40,737.44
|
|
|
HC INSERT SUBQ DEFIB WELTRD
|
Facility
|
IP
|
$77,865.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
906811456
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,573.00 |
| Max. Negotiated Rate |
$66,185.25 |
| Rate for Payer: Adventist Health Commercial |
$15,573.00
|
| Rate for Payer: Cash Price |
$42,825.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$31,146.00
|
| Rate for Payer: Galaxy Health WC |
$66,185.25
|
| Rate for Payer: Global Benefits Group Commercial |
$46,719.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51,935.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,666.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,198.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,687.60
|
| Rate for Payer: Multiplan Commercial |
$62,292.00
|
| Rate for Payer: Networks By Design Commercial |
$50,612.25
|
| Rate for Payer: Prime Health Services Commercial |
$66,185.25
|
|
|
HC INSERT SUPRAPUBIC CATH
|
Facility
|
IP
|
$6,854.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
909020122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,370.80 |
| Max. Negotiated Rate |
$5,825.90 |
| Rate for Payer: Adventist Health Commercial |
$1,370.80
|
| Rate for Payer: Cash Price |
$3,769.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,741.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,741.60
|
| Rate for Payer: Galaxy Health WC |
$5,825.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,112.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,611.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,242.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,644.96
|
| Rate for Payer: Multiplan Commercial |
$5,483.20
|
| Rate for Payer: Networks By Design Commercial |
$4,455.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,825.90
|
|
|
HC INSERT SUPRAPUBIC CATH
|
Facility
|
OP
|
$6,854.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
909020122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.84 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,370.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,769.70
|
| Rate for Payer: Cash Price |
$3,769.70
|
| Rate for Payer: Cash Price |
$3,769.70
|
| Rate for Payer: Cigna of CA HMO |
$4,386.56
|
| Rate for Payer: Cigna of CA PPO |
$5,071.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$5,825.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,112.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$462.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,644.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,483.20
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,455.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,825.90
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,112.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
