|
HC PLATELET PED PAK ALIQUOT
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904532
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$180.17 |
| Max. Negotiated Rate |
$776.90 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$599.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.29
|
| Rate for Payer: Cash Price |
$502.70
|
| Rate for Payer: Cash Price |
$502.70
|
| Rate for Payer: Cash Price |
$502.70
|
| Rate for Payer: Cigna of CA HMO |
$584.96
|
| Rate for Payer: Cigna of CA PPO |
$676.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$776.90
|
| Rate for Payer: Global Benefits Group Commercial |
$548.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$609.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$731.20
|
| Rate for Payer: Networks By Design Commercial |
$594.10
|
| Rate for Payer: Prime Health Services Commercial |
$776.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$548.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$548.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC PLATELET PED PAK ALIQUOT
|
Facility
|
IP
|
$914.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904532
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$182.80 |
| Max. Negotiated Rate |
$776.90 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Cash Price |
$502.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.60
|
| Rate for Payer: EPIC Health Plan Senior |
$365.60
|
| Rate for Payer: Galaxy Health WC |
$776.90
|
| Rate for Payer: Global Benefits Group Commercial |
$548.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$609.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$565.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.36
|
| Rate for Payer: Multiplan Commercial |
$731.20
|
| Rate for Payer: Networks By Design Commercial |
$594.10
|
| Rate for Payer: Prime Health Services Commercial |
$776.90
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
IP
|
$848.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$720.80 |
| Rate for Payer: Adventist Health Commercial |
$169.60
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.20
|
| Rate for Payer: EPIC Health Plan Senior |
$339.20
|
| Rate for Payer: Galaxy Health WC |
$720.80
|
| Rate for Payer: Global Benefits Group Commercial |
$508.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$565.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$524.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.52
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: Networks By Design Commercial |
$551.20
|
| Rate for Payer: Prime Health Services Commercial |
$720.80
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
OP
|
$848.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$837.33 |
| Rate for Payer: Adventist Health Commercial |
$169.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$556.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.76
|
| Rate for Payer: Blue Shield of California Commercial |
$518.98
|
| Rate for Payer: Blue Shield of California EPN |
$342.59
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cigna of CA HMO |
$542.72
|
| Rate for Payer: Cigna of CA PPO |
$627.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$720.80
|
| Rate for Payer: Global Benefits Group Commercial |
$508.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$565.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: Networks By Design Commercial |
$551.20
|
| Rate for Payer: Prime Health Services Commercial |
$720.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$508.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$508.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.89
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$409.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
OP
|
$7,427.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,485.40 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,485.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,892.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,721.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,928.23
|
| 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 |
$2,822.94
|
| Rate for Payer: Cash Price |
$4,084.85
|
| Rate for Payer: Cash Price |
$4,084.85
|
| Rate for Payer: Cash Price |
$4,084.85
|
| Rate for Payer: Cigna of CA HMO |
$4,753.28
|
| Rate for Payer: Cigna of CA PPO |
$5,495.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,892.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,721.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,928.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,703.11
|
| Rate for Payer: EPIC Health Plan Senior |
$7,928.23
|
| Rate for Payer: Galaxy Health WC |
$6,312.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,456.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,002.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,816.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,928.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,054.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,928.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,989.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,623.83
|
| Rate for Payer: Multiplan Commercial |
$5,941.60
|
| Rate for Payer: Multiplan WC |
$12,632.22
|
| Rate for Payer: Networks By Design Commercial |
$4,827.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.95
|
| Rate for Payer: Prime Health Services WC |
$12,503.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,456.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,928.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,892.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,721.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,928.23
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
IP
|
$7,427.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,485.40 |
| Max. Negotiated Rate |
$6,312.95 |
| Rate for Payer: Adventist Health Commercial |
$1,485.40
|
| Rate for Payer: Cash Price |
$4,084.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.80
|
| Rate for Payer: Galaxy Health WC |
$6,312.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,456.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,829.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,597.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.48
|
| Rate for Payer: Multiplan Commercial |
$5,941.60
|
| Rate for Payer: Networks By Design Commercial |
$4,827.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.95
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.40 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$305.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$934.52
|
| Rate for Payer: Blue Shield of California EPN |
$616.91
|
| Rate for Payer: Cash Price |
$839.85
|
| Rate for Payer: Cash Price |
$839.85
|
| Rate for Payer: Cash Price |
$839.85
|
| Rate for Payer: Cigna of CA HMO |
$977.28
|
| Rate for Payer: Cigna of CA PPO |
$1,129.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,297.95
|
| Rate for Payer: Global Benefits Group Commercial |
$916.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$827.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,018.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$935.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,221.60
|
| Rate for Payer: Networks By Design Commercial |
$992.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$916.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$916.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.50
|
| Rate for Payer: United Healthcare All Other HMO |
$763.50
|
| Rate for Payer: United Healthcare HMO Rider |
$763.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$763.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.40 |
| Max. Negotiated Rate |
$1,297.95 |
| Rate for Payer: Adventist Health Commercial |
$305.40
|
| Rate for Payer: Cash Price |
$839.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.80
|
| Rate for Payer: EPIC Health Plan Senior |
$610.80
|
| Rate for Payer: Galaxy Health WC |
$1,297.95
|
| Rate for Payer: Global Benefits Group Commercial |
$916.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,018.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$581.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$945.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.48
|
| Rate for Payer: Multiplan Commercial |
$1,221.60
|
| Rate for Payer: Networks By Design Commercial |
$992.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.95
|
|
|
HC PLCMNT LCL DVC PERC ADD LESION
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
909010036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$648.55 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.20
|
| Rate for Payer: EPIC Health Plan Senior |
$305.20
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.12
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
|
|
HC PLCMNT LCL DVC PERC ADD LESION
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
909010036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$648.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$419.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$572.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$466.96
|
| Rate for Payer: Blue Shield of California EPN |
$308.25
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: Cigna of CA HMO |
$488.32
|
| Rate for Payer: Cigna of CA PPO |
$564.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$648.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$648.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$648.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.20
|
| Rate for Payer: EPIC Health Plan Senior |
$305.20
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$723.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$818.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$534.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$534.10
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$457.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$457.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.50
|
| Rate for Payer: United Healthcare All Other HMO |
$381.50
|
| Rate for Payer: United Healthcare HMO Rider |
$381.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$381.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$648.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$648.55
|
| Rate for Payer: Vantage Medical Group Senior |
$648.55
|
|
|
HC PLCMNT NEPH CATH PERCU
|
Facility
|
IP
|
$8,942.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
909050432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,788.40 |
| Max. Negotiated Rate |
$7,600.70 |
| Rate for Payer: Adventist Health Commercial |
$1,788.40
|
| Rate for Payer: Cash Price |
$4,918.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,576.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,576.80
|
| Rate for Payer: Galaxy Health WC |
$7,600.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,365.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,964.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,406.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,535.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,146.08
|
| Rate for Payer: Multiplan Commercial |
$7,153.60
|
| Rate for Payer: Networks By Design Commercial |
$5,812.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,600.70
|
|
|
HC PLCMNT NEPH CATH PERCU
|
Facility
|
OP
|
$8,942.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
909050432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,299.72 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,788.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$4,918.10
|
| Rate for Payer: Cash Price |
$4,918.10
|
| Rate for Payer: Cash Price |
$4,918.10
|
| Rate for Payer: Cigna of CA HMO |
$5,722.88
|
| Rate for Payer: Cigna of CA PPO |
$6,617.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$7,600.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,365.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,299.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,964.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,469.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,146.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$7,153.60
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,812.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,600.70
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,365.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC PLCMNT NEPHU CATH PERCU
|
Facility
|
IP
|
$5,139.00
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
909050433
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,027.80 |
| Max. Negotiated Rate |
$4,368.15 |
| Rate for Payer: Adventist Health Commercial |
$1,027.80
|
| Rate for Payer: Cash Price |
$2,826.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,055.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,055.60
|
| Rate for Payer: Galaxy Health WC |
$4,368.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,083.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,427.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,957.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,181.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,233.36
|
| Rate for Payer: Multiplan Commercial |
$4,111.20
|
| Rate for Payer: Networks By Design Commercial |
$3,340.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,368.15
|
|
|
HC PLCMNT NEPHU CATH PERCU
|
Facility
|
OP
|
$5,139.00
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
909050433
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,027.80 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Adventist Health Commercial |
$1,027.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,826.45
|
| Rate for Payer: Cash Price |
$2,826.45
|
| Rate for Payer: Cash Price |
$2,826.45
|
| Rate for Payer: Cigna of CA HMO |
$3,288.96
|
| Rate for Payer: Cigna of CA PPO |
$3,802.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$4,368.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,083.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,752.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,427.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,982.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,233.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$4,111.20
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$3,340.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,368.15
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,083.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC PLCMNT TRANSESOPHEAGEAL PROBE
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT 93316
|
| Hospital Charge Code |
900501593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$414.60 |
| Max. Negotiated Rate |
$1,762.05 |
| Rate for Payer: Adventist Health Commercial |
$414.60
|
| Rate for Payer: Cash Price |
$1,140.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$829.20
|
| Rate for Payer: Galaxy Health WC |
$1,762.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,243.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,382.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,283.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.52
|
| Rate for Payer: Multiplan Commercial |
$1,658.40
|
| Rate for Payer: Networks By Design Commercial |
$1,347.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,762.05
|
|
|
HC PLCMNT TRANSESOPHEAGEAL PROBE
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
CPT 93316
|
| Hospital Charge Code |
900501593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$414.60 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$414.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$1,140.15
|
| Rate for Payer: Cash Price |
$1,140.15
|
| Rate for Payer: Cash Price |
$1,140.15
|
| Rate for Payer: Cigna of CA HMO |
$1,326.72
|
| Rate for Payer: Cigna of CA PPO |
$1,534.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$1,762.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,243.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,382.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$1,658.40
|
| Rate for Payer: Multiplan WC |
$1,110.02
|
| Rate for Payer: Networks By Design Commercial |
$1,347.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,762.05
|
| Rate for Payer: Prime Health Services WC |
$1,098.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,243.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,036.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,036.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,036.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP GT 5YR
|
Facility
|
IP
|
$12,298.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
909080010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,459.60 |
| Max. Negotiated Rate |
$10,453.30 |
| Rate for Payer: Adventist Health Commercial |
$2,459.60
|
| Rate for Payer: Cash Price |
$6,763.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,919.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,919.20
|
| Rate for Payer: Galaxy Health WC |
$10,453.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,378.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,685.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,612.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,951.52
|
| Rate for Payer: Multiplan Commercial |
$9,838.40
|
| Rate for Payer: Networks By Design Commercial |
$7,993.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,453.30
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP GT 5YR
|
Facility
|
OP
|
$12,298.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
909080010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.67 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,459.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$6,763.90
|
| Rate for Payer: Cash Price |
$6,763.90
|
| Rate for Payer: Cash Price |
$6,763.90
|
| Rate for Payer: Cigna of CA HMO |
$7,870.72
|
| Rate for Payer: Cigna of CA PPO |
$9,100.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,453.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,378.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,951.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,838.40
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,993.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,453.30
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,378.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP LT 5YR
|
Facility
|
OP
|
$11,279.00
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
909081359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.68 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,255.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$6,203.45
|
| Rate for Payer: Cash Price |
$6,203.45
|
| Rate for Payer: Cash Price |
$6,203.45
|
| Rate for Payer: Cigna of CA HMO |
$7,218.56
|
| Rate for Payer: Cigna of CA PPO |
$8,346.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$9,587.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,767.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,523.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,706.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$9,023.20
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$7,331.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,587.15
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,767.40
|
| 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 |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP LT 5YR
|
Facility
|
IP
|
$11,279.00
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
909081359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,255.80 |
| Max. Negotiated Rate |
$9,587.15 |
| Rate for Payer: EPIC Health Plan Senior |
$4,511.60
|
| Rate for Payer: Galaxy Health WC |
$9,587.15
|
| Rate for Payer: Adventist Health Commercial |
$2,255.80
|
| Rate for Payer: Cash Price |
$6,203.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,511.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,767.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,523.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,297.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,981.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,706.96
|
| Rate for Payer: Multiplan Commercial |
$9,023.20
|
| Rate for Payer: Networks By Design Commercial |
$7,331.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,587.15
|
|
|
HC PLCMT PERIPH INSRT CV DEVC W/P
|
Facility
|
OP
|
$10,415.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
909080016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$510.38 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cigna of CA HMO |
$6,665.60
|
| Rate for Payer: Cigna of CA PPO |
$7,707.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$510.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,946.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,332.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PLCMT PERIPH INSRT CV DEVC W/P
|
Facility
|
IP
|
$10,415.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
909080016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,083.00 |
| Max. Negotiated Rate |
$8,852.75 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,166.00
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,946.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,968.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,446.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Multiplan Commercial |
$8,332.00
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
|
|
HC PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
OP
|
$10,415.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$568.55 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cigna of CA HMO |
$6,665.60
|
| Rate for Payer: Cigna of CA PPO |
$7,707.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$568.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,946.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,332.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
IP
|
$10,415.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,083.00 |
| Max. Negotiated Rate |
$8,852.75 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,166.00
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,946.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,968.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,446.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Multiplan Commercial |
$8,332.00
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
|
|
HC PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
IP
|
$10,415.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,083.00 |
| Max. Negotiated Rate |
$8,852.75 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,166.00
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,946.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,968.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,446.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Multiplan Commercial |
$8,332.00
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
|
