|
HC INSERT SWAN TYPE CATHETER
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.26 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$484.00
|
| 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 |
$7,885.00
|
| Rate for Payer: Cash Price |
$1,331.00
|
| Rate for Payer: Cash Price |
$1,331.00
|
| Rate for Payer: Cash Price |
$1,331.00
|
| Rate for Payer: Cigna of CA HMO |
$1,548.80
|
| Rate for Payer: Cigna of CA PPO |
$1,790.80
|
| 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 |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| 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 |
$1,936.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,210.00
|
| 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 INSERT SWAN TYPE CATHETER
|
Facility
|
OP
|
$2,352.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906820056
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$213.33 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$470.40
|
| 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 |
$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 |
$1,293.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cigna of CA HMO |
$1,528.80
|
| Rate for Payer: Cigna of CA PPO |
$1,740.48
|
| 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 |
$1,999.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,411.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,568.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.48
|
| 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 |
$1,881.60
|
| Rate for Payer: Networks By Design Commercial |
$1,528.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,999.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,411.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,411.20
|
| 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 |
$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 INSERT SWAN TYPE CATHETER
|
Facility
|
IP
|
$2,352.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906820056
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$470.40 |
| Max. Negotiated Rate |
$1,999.20 |
| Rate for Payer: Adventist Health Commercial |
$470.40
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.80
|
| Rate for Payer: EPIC Health Plan Senior |
$940.80
|
| Rate for Payer: Galaxy Health WC |
$1,999.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,411.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,568.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$896.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,455.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.48
|
| Rate for Payer: Multiplan Commercial |
$1,881.60
|
| Rate for Payer: Networks By Design Commercial |
$1,528.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,999.20
|
|
|
HC INSERT SWAN TYPE CATHETER
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$2,057.00 |
| Rate for Payer: Adventist Health Commercial |
$484.00
|
| Rate for Payer: Cash Price |
$1,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.00
|
| Rate for Payer: EPIC Health Plan Senior |
$968.00
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,497.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Multiplan Commercial |
$1,936.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
|
|
HC INSERT SWAN TYPE CATHETER
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$213.33 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$484.00
|
| 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 |
$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 |
$1,331.00
|
| Rate for Payer: Cash Price |
$1,331.00
|
| Rate for Payer: Cash Price |
$1,331.00
|
| Rate for Payer: Cigna of CA HMO |
$1,573.00
|
| Rate for Payer: Cigna of CA PPO |
$1,790.80
|
| 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 |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| 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 |
$1,936.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,452.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,452.00
|
| 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 |
$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 INSERT SWAN TYPE CATHETER
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$2,057.00 |
| Rate for Payer: Adventist Health Commercial |
$484.00
|
| Rate for Payer: Cash Price |
$1,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.00
|
| Rate for Payer: EPIC Health Plan Senior |
$968.00
|
| Rate for Payer: Galaxy Health WC |
$2,057.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,452.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,614.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,497.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Multiplan Commercial |
$1,936.00
|
| Rate for Payer: Networks By Design Commercial |
$1,573.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,057.00
|
|
|
HC INSERT TEMP INDWELLING CATH
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
906820336
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| 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 |
$551.65
|
| Rate for Payer: Cash Price |
$551.65
|
| Rate for Payer: Cash Price |
$551.65
|
| Rate for Payer: Cigna of CA HMO |
$641.92
|
| Rate for Payer: Cigna of CA PPO |
$742.22
|
| 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 |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| 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 |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$501.50
|
| Rate for Payer: United Healthcare All Other HMO |
$501.50
|
| Rate for Payer: United Healthcare HMO Rider |
$501.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.50
|
| 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 TEMP INDWELLING CATH
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
906820336
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| Rate for Payer: Cash Price |
$551.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.20
|
| Rate for Payer: EPIC Health Plan Senior |
$401.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$620.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
|
|
HC INSERT TEMP INDWELLING CATH
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
906811256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$808.35 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.24
|
| Rate for Payer: Multiplan Commercial |
$760.80
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
|
|
HC INSERT TEMP INDWELLING CATH
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
906811256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| 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 |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cash Price |
$523.05
|
| Rate for Payer: Cigna of CA HMO |
$608.64
|
| Rate for Payer: Cigna of CA PPO |
$703.74
|
| 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 |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.24
|
| 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 |
$760.80
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$475.50
|
| Rate for Payer: United Healthcare All Other HMO |
$475.50
|
| Rate for Payer: United Healthcare HMO Rider |
$475.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$475.50
|
| 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 TEMP INTRAPERITONEAL CATH
|
Facility
|
IP
|
$7,381.00
|
|
|
Service Code
|
CPT 49421
|
| Hospital Charge Code |
902100045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,476.20 |
| Max. Negotiated Rate |
$6,273.85 |
| Rate for Payer: Adventist Health Commercial |
$1,476.20
|
| Rate for Payer: Cash Price |
$4,059.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,952.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,952.40
|
| Rate for Payer: Galaxy Health WC |
$6,273.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,428.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,923.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,568.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,771.44
|
| Rate for Payer: Multiplan Commercial |
$5,904.80
|
| Rate for Payer: Networks By Design Commercial |
$4,797.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,273.85
|
|
|
HC INSERT TEMP INTRAPERITONEAL CATH
|
Facility
|
OP
|
$7,381.00
|
|
|
Service Code
|
CPT 49421
|
| Hospital Charge Code |
902100045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.71 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,476.20
|
| 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 |
$4,059.55
|
| Rate for Payer: Cash Price |
$4,059.55
|
| Rate for Payer: Cash Price |
$4,059.55
|
| Rate for Payer: Cigna of CA HMO |
$4,723.84
|
| Rate for Payer: Cigna of CA PPO |
$5,461.94
|
| 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 |
$6,273.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,428.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,923.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,771.44
|
| 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 |
$5,904.80
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$4,797.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,273.85
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,428.60
|
| 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 URINARY CATH COMPLICATED
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
902400104
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$725.05 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$341.20
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.72
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
|
|
HC INSERT URINARY CATH COMPLICATED
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
902400104
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$725.05 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$341.20
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.72
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
|
|
HC INSERT URINARY CATH COMPLICATED
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
902400104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$725.05 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$341.20
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.72
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
|
|
HC INSERT URINARY CATH COMPLICATED
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
902400104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cigna of CA HMO |
$545.92
|
| Rate for Payer: Cigna of CA PPO |
$631.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: Multiplan WC |
$316.75
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
| Rate for Payer: Prime Health Services WC |
$313.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.50
|
| Rate for Payer: United Healthcare All Other HMO |
$426.50
|
| Rate for Payer: United Healthcare HMO Rider |
$426.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$426.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC INSERT URINARY CATH COMPLICATED
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
902400104
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cigna of CA HMO |
$545.92
|
| Rate for Payer: Cigna of CA PPO |
$631.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC INSERT URINARY CATH COMPLICATED
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
902400104
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cash Price |
$469.15
|
| Rate for Payer: Cigna of CA HMO |
$545.92
|
| Rate for Payer: Cigna of CA PPO |
$631.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.50
|
| Rate for Payer: United Healthcare All Other HMO |
$426.50
|
| Rate for Payer: United Healthcare HMO Rider |
$426.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$426.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC INSERT VAD ARTERY ACCESS
|
Facility
|
IP
|
$14,278.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
906820232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,855.60 |
| Max. Negotiated Rate |
$12,136.30 |
| Rate for Payer: Adventist Health Commercial |
$2,855.60
|
| Rate for Payer: Cash Price |
$7,852.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,711.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,711.20
|
| Rate for Payer: Galaxy Health WC |
$12,136.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,566.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,523.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,439.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,838.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,426.72
|
| Rate for Payer: Multiplan Commercial |
$11,422.40
|
| Rate for Payer: Networks By Design Commercial |
$9,280.70
|
| Rate for Payer: Prime Health Services Commercial |
$12,136.30
|
|
|
HC INSERT VAD ARTERY ACCESS
|
Facility
|
OP
|
$14,278.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
906820232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.81 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,855.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,136.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,852.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,708.50
|
| 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 |
$5,369.02
|
| Rate for Payer: Cash Price |
$7,852.90
|
| Rate for Payer: Cash Price |
$7,852.90
|
| Rate for Payer: Cash Price |
$7,852.90
|
| Rate for Payer: Cigna of CA HMO |
$9,137.92
|
| Rate for Payer: Cigna of CA PPO |
$10,565.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,136.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,136.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,136.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,711.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,711.20
|
| Rate for Payer: Galaxy Health WC |
$12,136.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,566.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$589.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,523.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,838.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,426.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,994.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,994.60
|
| Rate for Payer: Multiplan Commercial |
$11,422.40
|
| Rate for Payer: Networks By Design Commercial |
$9,280.70
|
| Rate for Payer: Prime Health Services Commercial |
$12,136.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,566.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$12,136.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,136.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12,136.30
|
|
|
HC INSERT VAD ARTERY ACCESS
|
Facility
|
IP
|
$14,691.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
906811429
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,938.20 |
| Max. Negotiated Rate |
$12,487.35 |
| Rate for Payer: Adventist Health Commercial |
$2,938.20
|
| Rate for Payer: Cash Price |
$8,080.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,876.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,876.40
|
| Rate for Payer: Galaxy Health WC |
$12,487.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,814.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,798.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,597.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,093.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.84
|
| Rate for Payer: Multiplan Commercial |
$11,752.80
|
| Rate for Payer: Networks By Design Commercial |
$9,549.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,487.35
|
|
|
HC INSERT VAD ARTERY ACCESS
|
Facility
|
OP
|
$14,691.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
906811429
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.81 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,938.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,487.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,080.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,018.25
|
| 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 |
$5,369.02
|
| Rate for Payer: Cash Price |
$8,080.05
|
| Rate for Payer: Cash Price |
$8,080.05
|
| Rate for Payer: Cash Price |
$8,080.05
|
| Rate for Payer: Cigna of CA HMO |
$9,402.24
|
| Rate for Payer: Cigna of CA PPO |
$10,871.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,487.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,487.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,487.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,876.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,876.40
|
| Rate for Payer: Galaxy Health WC |
$12,487.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,814.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$589.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,798.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,093.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,283.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,283.70
|
| Rate for Payer: Multiplan Commercial |
$11,752.80
|
| Rate for Payer: Networks By Design Commercial |
$9,549.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,814.60
|
| 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 |
$12,487.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,487.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,487.35
|
|
|
HC INSJ PERM CCM DFIB SYS DUAL LEADS
|
Facility
|
OP
|
$22,601.00
|
|
|
Service Code
|
CPT 0918T
|
| Hospital Charge Code |
906811506
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$19,210.85 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,879.27
|
| 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 |
$12,430.55
|
| Rate for Payer: Cash Price |
$12,430.55
|
| Rate for Payer: Cash Price |
$12,430.55
|
| Rate for Payer: Cigna of CA HMO |
$14,464.64
|
| Rate for Payer: Cigna of CA PPO |
$16,724.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$19,210.85
|
| Rate for Payer: Global Benefits Group Commercial |
$13,560.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,074.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,610.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,424.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$18,080.80
|
| Rate for Payer: Networks By Design Commercial |
$14,690.65
|
| Rate for Payer: Prime Health Services Commercial |
$19,210.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,560.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,560.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC INSJ PERM CCM DFIB SYS DUAL LEADS
|
Facility
|
IP
|
$22,601.00
|
|
|
Service Code
|
CPT 0918T
|
| Hospital Charge Code |
906811506
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,520.20 |
| Max. Negotiated Rate |
$19,210.85 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Cash Price |
$12,430.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,040.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,040.40
|
| Rate for Payer: Galaxy Health WC |
$19,210.85
|
| Rate for Payer: Global Benefits Group Commercial |
$13,560.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,074.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,610.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,990.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,424.24
|
| Rate for Payer: Multiplan Commercial |
$18,080.80
|
| Rate for Payer: Networks By Design Commercial |
$14,690.65
|
| Rate for Payer: Prime Health Services Commercial |
$19,210.85
|
|
|
HC INSJ PERM CCM DFIB SYS PG AND ELTRD
|
Facility
|
IP
|
$87,556.00
|
|
|
Service Code
|
CPT 0915T
|
| Hospital Charge Code |
906811503
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$17,511.20 |
| Max. Negotiated Rate |
$74,422.60 |
| Rate for Payer: Adventist Health Commercial |
$17,511.20
|
| Rate for Payer: Cash Price |
$48,155.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$35,022.40
|
| Rate for Payer: Galaxy Health WC |
$74,422.60
|
| Rate for Payer: Global Benefits Group Commercial |
$52,533.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58,399.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,358.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54,197.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,013.44
|
| Rate for Payer: Multiplan Commercial |
$70,044.80
|
| Rate for Payer: Networks By Design Commercial |
$56,911.40
|
| Rate for Payer: Prime Health Services Commercial |
$74,422.60
|
|
