|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
OP
|
$14,515.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,903.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,903.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$6,531.75
|
| Rate for Payer: Cash Price |
$6,531.75
|
| Rate for Payer: Cash Price |
$6,531.75
|
| Rate for Payer: Cigna of CA HMO |
$9,289.60
|
| Rate for Payer: Cigna of CA PPO |
$10,741.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$12,337.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,709.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,681.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,483.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$11,612.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$9,434.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,337.75
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,709.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
IP
|
$14,515.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,903.00 |
| Max. Negotiated Rate |
$12,337.75 |
| Rate for Payer: Adventist Health Commercial |
$2,903.00
|
| Rate for Payer: Cash Price |
$6,531.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,806.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,806.00
|
| Rate for Payer: Galaxy Health WC |
$12,337.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,709.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,681.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,530.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,984.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,483.60
|
| Rate for Payer: Multiplan Commercial |
$11,612.00
|
| Rate for Payer: Networks By Design Commercial |
$9,434.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,337.75
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
IP
|
$29,033.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906820314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,806.60 |
| Max. Negotiated Rate |
$24,678.05 |
| Rate for Payer: Adventist Health Commercial |
$5,806.60
|
| Rate for Payer: Cash Price |
$13,064.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,613.20
|
| Rate for Payer: Galaxy Health WC |
$24,678.05
|
| Rate for Payer: Global Benefits Group Commercial |
$17,419.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,365.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,061.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,971.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,967.92
|
| Rate for Payer: Multiplan Commercial |
$23,226.40
|
| Rate for Payer: Networks By Design Commercial |
$18,871.45
|
| Rate for Payer: Prime Health Services Commercial |
$24,678.05
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
OP
|
$29,033.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906820314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,806.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$13,064.85
|
| Rate for Payer: Cash Price |
$13,064.85
|
| Rate for Payer: Cash Price |
$13,064.85
|
| Rate for Payer: Cigna of CA HMO |
$18,581.12
|
| Rate for Payer: Cigna of CA PPO |
$21,484.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$24,678.05
|
| Rate for Payer: Global Benefits Group Commercial |
$17,419.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,365.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,967.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$23,226.40
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$18,871.45
|
| Rate for Payer: Prime Health Services Commercial |
$24,678.05
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,419.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
OP
|
$29,033.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906820313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,806.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$13,064.85
|
| Rate for Payer: Cash Price |
$13,064.85
|
| Rate for Payer: Cash Price |
$13,064.85
|
| Rate for Payer: Cigna of CA HMO |
$18,581.12
|
| Rate for Payer: Cigna of CA PPO |
$21,484.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$24,678.05
|
| Rate for Payer: Global Benefits Group Commercial |
$17,419.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,365.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,967.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$23,226.40
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$18,871.45
|
| Rate for Payer: Prime Health Services Commercial |
$24,678.05
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,419.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
IP
|
$29,033.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906820313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,806.60 |
| Max. Negotiated Rate |
$24,678.05 |
| Rate for Payer: Adventist Health Commercial |
$5,806.60
|
| Rate for Payer: Cash Price |
$13,064.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,613.20
|
| Rate for Payer: Galaxy Health WC |
$24,678.05
|
| Rate for Payer: Global Benefits Group Commercial |
$17,419.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,365.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,061.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,971.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,967.92
|
| Rate for Payer: Multiplan Commercial |
$23,226.40
|
| Rate for Payer: Networks By Design Commercial |
$18,871.45
|
| Rate for Payer: Prime Health Services Commercial |
$24,678.05
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
OP
|
$5,572.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,114.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,114.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,736.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,064.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,179.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,421.77
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,507.40
|
| Rate for Payer: Cash Price |
$2,507.40
|
| Rate for Payer: Cigna of CA HMO |
$3,621.80
|
| Rate for Payer: Cigna of CA PPO |
$4,123.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,736.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,736.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,736.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,228.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,228.80
|
| Rate for Payer: Galaxy Health WC |
$4,736.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,343.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,716.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,122.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,449.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,337.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,900.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,900.40
|
| Rate for Payer: Multiplan Commercial |
$4,457.60
|
| Rate for Payer: Networks By Design Commercial |
$3,621.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,736.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,343.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,343.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,786.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,786.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,786.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,786.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,736.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,736.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,736.20
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
IP
|
$5,572.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,114.40 |
| Max. Negotiated Rate |
$4,736.20 |
| Rate for Payer: Adventist Health Commercial |
$1,114.40
|
| Rate for Payer: Cash Price |
$2,507.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,228.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,228.80
|
| Rate for Payer: Galaxy Health WC |
$4,736.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,343.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,716.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,122.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,449.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,337.28
|
| Rate for Payer: Multiplan Commercial |
$4,457.60
|
| Rate for Payer: Networks By Design Commercial |
$3,621.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,736.20
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$518.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cigna of CA HMO |
$603.52
|
| Rate for Payer: Cigna of CA PPO |
$697.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$801.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$801.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$801.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$660.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$660.10
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$801.55
|
| Rate for Payer: Vantage Medical Group Senior |
$801.55
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$556.16
|
| Rate for Payer: Cigna of CA PPO |
$643.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$518.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cigna of CA HMO |
$603.52
|
| Rate for Payer: Cigna of CA PPO |
$697.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$801.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$801.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$801.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,186.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,472.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$660.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$660.10
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$801.55
|
| Rate for Payer: Vantage Medical Group Senior |
$801.55
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,522.35 |
| Rate for Payer: Adventist Health Commercial |
$358.20
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$716.40
|
| Rate for Payer: Galaxy Health WC |
$1,522.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,108.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.84
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: Networks By Design Commercial |
$1,164.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,522.35
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
OP
|
$1,791.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.48 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$358.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,522.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,343.25
|
| 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 |
$570.02
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Cigna of CA HMO |
$1,146.24
|
| Rate for Payer: Cigna of CA PPO |
$1,325.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,522.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,522.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,522.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$716.40
|
| Rate for Payer: Galaxy Health WC |
$1,522.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,108.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,253.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,253.70
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: Networks By Design Commercial |
$1,164.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,522.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,074.60
|
| 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 |
$1,522.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,522.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,522.35
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.80 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: Adventist Health Commercial |
$234.80
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$469.60
|
| Rate for Payer: Galaxy Health WC |
$997.90
|
| Rate for Payer: Global Benefits Group Commercial |
$704.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.76
|
| Rate for Payer: Multiplan Commercial |
$939.20
|
| Rate for Payer: Networks By Design Commercial |
$763.10
|
| Rate for Payer: Prime Health Services Commercial |
$997.90
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.80 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$234.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$880.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: Cash Price |
$528.30
|
| Rate for Payer: Cigna of CA HMO |
$751.36
|
| Rate for Payer: Cigna of CA PPO |
$868.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$469.60
|
| Rate for Payer: Galaxy Health WC |
$997.90
|
| Rate for Payer: Global Benefits Group Commercial |
$704.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$821.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$821.80
|
| Rate for Payer: Multiplan Commercial |
$939.20
|
| Rate for Payer: Networks By Design Commercial |
$763.10
|
| Rate for Payer: Prime Health Services Commercial |
$997.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$704.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.90
|
| Rate for Payer: Vantage Medical Group Senior |
$997.90
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$312.73 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$317.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$873.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Cigna of CA HMO |
$1,016.32
|
| Rate for Payer: Cigna of CA PPO |
$1,175.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,349.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,349.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Senior |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$982.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,111.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,111.60
|
| Rate for Payer: Multiplan Commercial |
$1,270.40
|
| Rate for Payer: Networks By Design Commercial |
$1,032.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$952.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,349.80
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$1,349.80 |
| Rate for Payer: Adventist Health Commercial |
$317.60
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Senior |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$982.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.12
|
| Rate for Payer: Multiplan Commercial |
$1,270.40
|
| Rate for Payer: Networks By Design Commercial |
$1,032.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
OP
|
$1,171.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.27 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$234.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: Cigna of CA HMO |
$749.44
|
| Rate for Payer: Cigna of CA PPO |
$866.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$995.35
|
| Rate for Payer: Global Benefits Group Commercial |
$702.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$761.15
|
| Rate for Payer: Prime Health Services Commercial |
$995.35
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$585.50
|
| Rate for Payer: United Healthcare All Other HMO |
$585.50
|
| Rate for Payer: United Healthcare HMO Rider |
$585.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$585.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
IP
|
$1,171.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.20 |
| Max. Negotiated Rate |
$995.35 |
| Rate for Payer: Adventist Health Commercial |
$234.20
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.40
|
| Rate for Payer: EPIC Health Plan Senior |
$468.40
|
| Rate for Payer: Galaxy Health WC |
$995.35
|
| Rate for Payer: Global Benefits Group Commercial |
$702.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.04
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: Networks By Design Commercial |
$761.15
|
| Rate for Payer: Prime Health Services Commercial |
$995.35
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$2,363.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.60 |
| Max. Negotiated Rate |
$2,008.55 |
| Rate for Payer: Adventist Health Commercial |
$472.60
|
| Rate for Payer: Cash Price |
$1,063.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$945.20
|
| Rate for Payer: Galaxy Health WC |
$2,008.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,576.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$900.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,462.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.12
|
| Rate for Payer: Multiplan Commercial |
$1,890.40
|
| Rate for Payer: Networks By Design Commercial |
$1,535.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,008.55
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$459.40 |
| Max. Negotiated Rate |
$1,952.45 |
| Rate for Payer: Adventist Health Commercial |
$459.40
|
| Rate for Payer: Cash Price |
$1,033.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$918.80
|
| Rate for Payer: Galaxy Health WC |
$1,952.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,378.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$875.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,421.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.28
|
| Rate for Payer: Multiplan Commercial |
$1,837.60
|
| Rate for Payer: Networks By Design Commercial |
$1,493.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,952.45
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$459.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$459.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$1,033.65
|
| Rate for Payer: Cash Price |
$1,033.65
|
| Rate for Payer: Cash Price |
$1,033.65
|
| Rate for Payer: Cigna of CA HMO |
$1,470.08
|
| Rate for Payer: Cigna of CA PPO |
$1,699.78
|
| 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 |
$1,952.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,378.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$870.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.28
|
| 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 |
$1,837.60
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$1,493.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,952.45
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,378.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
