|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$942.08
|
| Rate for Payer: Cigna of CA PPO |
$1,089.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.00
|
| Rate for Payer: United Healthcare All Other HMO |
$736.00
|
| Rate for Payer: United Healthcare HMO Rider |
$736.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$736.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,251.20 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$942.08
|
| Rate for Payer: Cigna of CA PPO |
$1,089.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$670.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$262.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$262.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$688.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,043.13
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.50
|
| Rate for Payer: United Healthcare All Other HMO |
$817.50
|
| Rate for Payer: United Healthcare HMO Rider |
$817.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$817.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$394.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$366.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$261.86
|
| Rate for Payer: Blue Shield of California Commercial |
$396.84
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cigna of CA HMO |
$398.08
|
| Rate for Payer: Cigna of CA PPO |
$460.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$482.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$394.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$366.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$373.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$373.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$311.00
|
| Rate for Payer: United Healthcare All Other HMO |
$311.00
|
| Rate for Payer: United Healthcare HMO Rider |
$311.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$311.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cigna of CA HMO |
$398.08
|
| Rate for Payer: Cigna of CA PPO |
$460.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$482.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$394.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$366.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$373.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$311.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$394.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$366.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
|
|
HC INNER CANNULA
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC INNER CANNULA
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
IP
|
$9,465.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,893.00 |
| Max. Negotiated Rate |
$8,045.25 |
| Rate for Payer: Adventist Health Commercial |
$1,893.00
|
| Rate for Payer: Cash Price |
$4,259.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,625.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,786.00
|
| Rate for Payer: Galaxy Health WC |
$8,045.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,679.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,010.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,584.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,271.60
|
| Rate for Payer: Multiplan Commercial |
$7,572.00
|
| Rate for Payer: Networks By Design Commercial |
$6,152.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,045.25
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
OP
|
$9,465.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.69 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,893.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$4,259.25
|
| Rate for Payer: Cash Price |
$4,259.25
|
| Rate for Payer: Cash Price |
$4,259.25
|
| Rate for Payer: Cigna of CA HMO |
$6,057.60
|
| Rate for Payer: Cigna of CA PPO |
$7,004.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,625.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$8,045.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,679.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$429.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,010.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,271.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$7,572.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,152.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,045.25
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,679.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,732.50
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC INSERT BRONCHIAL VALVE
|
Facility
|
OP
|
$6,786.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.85 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Adventist Health Commercial |
$1,357.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$3,053.70
|
| Rate for Payer: Cash Price |
$3,053.70
|
| Rate for Payer: Cash Price |
$3,053.70
|
| Rate for Payer: Cigna of CA HMO |
$4,343.04
|
| Rate for Payer: Cigna of CA PPO |
$5,021.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,750.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Galaxy Health WC |
$5,768.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,071.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$310.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,309.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,628.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,437.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$5,428.80
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: Networks By Design Commercial |
$4,410.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,768.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,071.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,393.00
|
| 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 |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
HC INSERT BRONCHIAL VALVE
|
Facility
|
IP
|
$6,786.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,357.20 |
| Max. Negotiated Rate |
$5,768.10 |
| Rate for Payer: Adventist Health Commercial |
$1,357.20
|
| Rate for Payer: Cash Price |
$3,053.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,750.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,714.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.40
|
| Rate for Payer: Galaxy Health WC |
$5,768.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,071.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,309.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,003.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,628.64
|
| Rate for Payer: Multiplan Commercial |
$5,428.80
|
| Rate for Payer: Networks By Design Commercial |
$4,410.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,768.10
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
OP
|
$3,958.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$609.82 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$791.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cigna of CA HMO |
$2,533.12
|
| Rate for Payer: Cigna of CA PPO |
$2,928.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,770.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$3,364.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$609.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,513.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$689.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$3,166.40
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,572.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,364.30
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,374.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,979.00
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
IP
|
$3,958.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$791.60 |
| Max. Negotiated Rate |
$3,364.30 |
| Rate for Payer: Adventist Health Commercial |
$791.60
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,770.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,583.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,583.20
|
| Rate for Payer: Galaxy Health WC |
$3,364.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,513.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,335.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.92
|
| Rate for Payer: Multiplan Commercial |
$3,166.40
|
| Rate for Payer: Networks By Design Commercial |
$2,572.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,364.30
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
OP
|
$2,245.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cigna of CA HMO |
$1,436.80
|
| Rate for Payer: Cigna of CA PPO |
$1,661.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,571.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,425.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$734.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$1,796.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,908.25
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,347.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,122.50
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
IP
|
$2,245.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$1,908.25 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,571.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$898.00
|
| Rate for Payer: EPIC Health Plan Senior |
$898.00
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,425.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,324.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.80
|
| Rate for Payer: Multiplan Commercial |
$1,796.00
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,908.25
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906811389
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906811389
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$235.52
|
| Rate for Payer: Cigna of CA PPO |
$272.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.00
|
| Rate for Payer: United Healthcare All Other HMO |
$184.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
