|
HC REMOVE URETER STENT, PERCUT
|
Facility
|
IP
|
$10,052.00
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
909081851
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,010.40 |
| Max. Negotiated Rate |
$8,544.20 |
| Rate for Payer: Adventist Health Commercial |
$2,010.40
|
| Rate for Payer: Cash Price |
$4,523.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,020.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,020.80
|
| Rate for Payer: Galaxy Health WC |
$8,544.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,031.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,704.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,829.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,222.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,412.48
|
| Rate for Payer: Multiplan Commercial |
$8,041.60
|
| Rate for Payer: Networks By Design Commercial |
$6,533.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,544.20
|
|
|
HC REMOVE URETER STENT, PERCUT
|
Facility
|
OP
|
$10,052.00
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
909081851
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,010.40 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,010.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$4,523.40
|
| Rate for Payer: Cash Price |
$4,523.40
|
| Rate for Payer: Cash Price |
$4,523.40
|
| Rate for Payer: Cigna of CA HMO |
$6,433.28
|
| Rate for Payer: Cigna of CA PPO |
$7,438.48
|
| 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 |
$8,544.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,031.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,213.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,704.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,503.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,412.48
|
| 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 |
$8,041.60
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$6,533.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,544.20
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,031.20
|
| 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 REMOVE VAD DIFF SESSION
|
Facility
|
OP
|
$7,217.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906820233
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$278.96 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,969.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,412.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,369.02
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cigna of CA HMO |
$4,691.05
|
| Rate for Payer: Cigna of CA PPO |
$5,340.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,134.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,134.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,886.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,886.80
|
| Rate for Payer: Galaxy Health WC |
$6,134.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,330.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,467.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,732.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,051.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,051.90
|
| Rate for Payer: Multiplan Commercial |
$5,773.60
|
| Rate for Payer: Networks By Design Commercial |
$4,691.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,134.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,330.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,330.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,134.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,134.45
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
OP
|
$7,426.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906811430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$278.96 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,084.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,569.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,369.02
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Cigna of CA HMO |
$4,826.90
|
| Rate for Payer: Cigna of CA PPO |
$5,495.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,312.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,312.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Galaxy Health WC |
$6,312.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,455.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,596.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,198.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,198.20
|
| Rate for Payer: Multiplan Commercial |
$5,940.80
|
| Rate for Payer: Networks By Design Commercial |
$4,826.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,455.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,455.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,312.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,312.10
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
IP
|
$7,217.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906820233
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,443.40 |
| Max. Negotiated Rate |
$6,134.45 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,886.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,886.80
|
| Rate for Payer: Galaxy Health WC |
$6,134.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,330.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,749.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,467.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,732.08
|
| Rate for Payer: Multiplan Commercial |
$5,773.60
|
| Rate for Payer: Networks By Design Commercial |
$4,691.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,134.45
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
IP
|
$7,426.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906811430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,485.20 |
| Max. Negotiated Rate |
$6,312.10 |
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Galaxy Health WC |
$6,312.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,455.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,829.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,596.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.24
|
| Rate for Payer: Multiplan Commercial |
$5,940.80
|
| Rate for Payer: Networks By Design Commercial |
$4,826.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.10
|
|
|
HC REMOVE VENTILATING TUBE
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
900501512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,005.80 |
| Max. Negotiated Rate |
$4,274.65 |
| Rate for Payer: Adventist Health Commercial |
$1,005.80
|
| Rate for Payer: Cash Price |
$2,263.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,011.60
|
| Rate for Payer: Galaxy Health WC |
$4,274.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,017.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,354.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,916.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,112.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.96
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: Networks By Design Commercial |
$3,268.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,274.65
|
|
|
HC REMOVE VENTILATING TUBE
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
900501512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$6,757.85 |
| Rate for Payer: Adventist Health Commercial |
$1,005.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,263.05
|
| Rate for Payer: Cash Price |
$2,263.05
|
| Rate for Payer: Cash Price |
$2,263.05
|
| Rate for Payer: Cigna of CA HMO |
$3,218.56
|
| Rate for Payer: Cigna of CA PPO |
$3,721.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$4,274.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,017.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,354.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,268.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,274.65
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,017.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,514.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,514.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,514.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,514.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
OP
|
$6,355.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
900501752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.17 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$1,271.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,859.75
|
| Rate for Payer: Cash Price |
$2,859.75
|
| Rate for Payer: Cash Price |
$2,859.75
|
| Rate for Payer: Cigna of CA HMO |
$4,067.20
|
| Rate for Payer: Cigna of CA PPO |
$4,702.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$5,401.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,238.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,084.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,130.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,401.75
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,813.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,177.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,177.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,177.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,177.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
OP
|
$6,355.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
909081361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$268.95 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,271.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$2,859.75
|
| Rate for Payer: Cash Price |
$2,859.75
|
| Rate for Payer: Cash Price |
$2,859.75
|
| Rate for Payer: Cigna of CA HMO |
$4,067.20
|
| Rate for Payer: Cigna of CA PPO |
$4,702.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$5,401.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,238.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,084.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,130.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,401.75
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,813.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
IP
|
$6,355.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
909081361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,271.00 |
| Max. Negotiated Rate |
$5,401.75 |
| Rate for Payer: Adventist Health Commercial |
$1,271.00
|
| Rate for Payer: Cash Price |
$2,859.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,542.00
|
| Rate for Payer: Galaxy Health WC |
$5,401.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,238.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,421.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,933.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.20
|
| Rate for Payer: Multiplan Commercial |
$5,084.00
|
| Rate for Payer: Networks By Design Commercial |
$4,130.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,401.75
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
IP
|
$6,355.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
900501752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,271.00 |
| Max. Negotiated Rate |
$5,401.75 |
| Rate for Payer: Adventist Health Commercial |
$1,271.00
|
| Rate for Payer: Cash Price |
$2,859.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,542.00
|
| Rate for Payer: Galaxy Health WC |
$5,401.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,238.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,421.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,933.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.20
|
| Rate for Payer: Multiplan Commercial |
$5,084.00
|
| Rate for Payer: Networks By Design Commercial |
$4,130.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,401.75
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
IP
|
$2,424.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.80 |
| Max. Negotiated Rate |
$2,060.40 |
| Rate for Payer: Adventist Health Commercial |
$484.80
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$969.60
|
| Rate for Payer: EPIC Health Plan Senior |
$969.60
|
| Rate for Payer: Galaxy Health WC |
$2,060.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,454.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,616.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,500.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.76
|
| Rate for Payer: Multiplan Commercial |
$1,939.20
|
| Rate for Payer: Networks By Design Commercial |
$1,575.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,060.40
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
IP
|
$3,280.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$656.00 |
| Max. Negotiated Rate |
$2,788.00 |
| Rate for Payer: Adventist Health Commercial |
$656.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,312.00
|
| Rate for Payer: Galaxy Health WC |
$2,788.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,968.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,249.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,030.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.20
|
| Rate for Payer: Multiplan Commercial |
$2,624.00
|
| Rate for Payer: Networks By Design Commercial |
$2,132.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,788.00
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,424.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$484.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,060.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,333.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,818.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,488.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: Cigna of CA HMO |
$1,551.36
|
| Rate for Payer: Cigna of CA PPO |
$1,793.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,060.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,060.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,060.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$969.60
|
| Rate for Payer: EPIC Health Plan Senior |
$969.60
|
| Rate for Payer: Galaxy Health WC |
$2,060.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,454.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,616.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,500.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,696.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,696.80
|
| Rate for Payer: Multiplan Commercial |
$1,939.20
|
| Rate for Payer: Networks By Design Commercial |
$1,575.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,060.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,454.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,212.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,212.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,212.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,212.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,060.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,060.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,060.40
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
OP
|
$3,280.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$656.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$656.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,788.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,804.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,460.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,014.25
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna of CA HMO |
$2,099.20
|
| Rate for Payer: Cigna of CA PPO |
$2,427.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,788.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,788.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,788.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,312.00
|
| Rate for Payer: Galaxy Health WC |
$2,788.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,968.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,249.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,030.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,296.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,296.00
|
| Rate for Payer: Multiplan Commercial |
$2,624.00
|
| Rate for Payer: Networks By Design Commercial |
$2,132.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,788.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,640.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,640.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,640.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,640.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,788.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,788.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,788.00
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
OP
|
$7,345.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$572.93 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,469.00
|
| 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 |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: Cigna of CA HMO |
$4,700.80
|
| Rate for Payer: Cigna of CA PPO |
$5,435.30
|
| 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 |
$6,243.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,407.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$572.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,899.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,876.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,774.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,243.25
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,407.00
|
| 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 RENAL BILAT 2ND ORDER
|
Facility
|
OP
|
$9,937.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
906820208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$572.93 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.40
|
| 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 |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,471.65
|
| Rate for Payer: Cash Price |
$4,471.65
|
| Rate for Payer: Cash Price |
$4,471.65
|
| Rate for Payer: Cigna of CA HMO |
$6,359.68
|
| Rate for Payer: Cigna of CA PPO |
$7,353.38
|
| 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 |
$8,446.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$572.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,627.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,384.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,949.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,459.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,446.45
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.20
|
| 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 |
$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 RENAL BILAT 2ND ORDER
|
Facility
|
IP
|
$9,937.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
906820208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,987.40 |
| Max. Negotiated Rate |
$8,446.45 |
| Rate for Payer: Galaxy Health WC |
$8,446.45
|
| Rate for Payer: Adventist Health Commercial |
$1,987.40
|
| Rate for Payer: Cash Price |
$4,471.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,974.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,974.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,627.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,151.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,384.88
|
| Rate for Payer: Multiplan Commercial |
$7,949.60
|
| Rate for Payer: Networks By Design Commercial |
$6,459.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,446.45
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
IP
|
$7,345.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,469.00 |
| Max. Negotiated Rate |
$6,243.25 |
| Rate for Payer: Adventist Health Commercial |
$1,469.00
|
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,938.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,938.00
|
| Rate for Payer: Galaxy Health WC |
$6,243.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,899.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,798.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,546.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.80
|
| Rate for Payer: Multiplan Commercial |
$5,876.00
|
| Rate for Payer: Networks By Design Commercial |
$4,774.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,243.25
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
OP
|
$7,714.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$498.49 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.80
|
| 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 |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,471.30
|
| Rate for Payer: Cash Price |
$3,471.30
|
| Rate for Payer: Cash Price |
$3,471.30
|
| Rate for Payer: Cigna of CA HMO |
$4,936.96
|
| Rate for Payer: Cigna of CA PPO |
$5,708.36
|
| 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 |
$6,556.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,628.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$498.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.36
|
| 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 |
$6,171.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$5,014.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.90
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,628.40
|
| 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 RENAL BILAT SELECTIVE INC AO
|
Facility
|
OP
|
$10,436.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
906820207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$498.49 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,087.20
|
| 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 |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,696.20
|
| Rate for Payer: Cash Price |
$4,696.20
|
| Rate for Payer: Cash Price |
$4,696.20
|
| Rate for Payer: Cigna of CA HMO |
$6,679.04
|
| Rate for Payer: Cigna of CA PPO |
$7,722.64
|
| 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 |
$8,870.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,261.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$498.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,960.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,504.64
|
| 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 |
$8,348.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,783.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,870.60
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,261.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 RENAL BILAT SELECTIVE INC AO
|
Facility
|
IP
|
$7,714.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,542.80 |
| Max. Negotiated Rate |
$6,556.90 |
| Rate for Payer: Adventist Health Commercial |
$1,542.80
|
| Rate for Payer: Cash Price |
$3,471.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.60
|
| Rate for Payer: Galaxy Health WC |
$6,556.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,628.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,939.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.36
|
| Rate for Payer: Multiplan Commercial |
$6,171.20
|
| Rate for Payer: Networks By Design Commercial |
$5,014.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.90
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
IP
|
$10,436.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
906820207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,087.20 |
| Max. Negotiated Rate |
$8,870.60 |
| Rate for Payer: Adventist Health Commercial |
$2,087.20
|
| Rate for Payer: Cash Price |
$4,696.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,174.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,174.40
|
| Rate for Payer: Galaxy Health WC |
$8,870.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,261.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,960.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,976.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,459.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,504.64
|
| Rate for Payer: Multiplan Commercial |
$8,348.80
|
| Rate for Payer: Networks By Design Commercial |
$6,783.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,870.60
|
|
|
HC RENAL BIOP PERCUT BY NEEDLE
|
Facility
|
IP
|
$4,780.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
903800069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$956.00 |
| Max. Negotiated Rate |
$4,063.00 |
| Rate for Payer: Adventist Health Commercial |
$956.00
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,912.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,912.00
|
| Rate for Payer: Galaxy Health WC |
$4,063.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,868.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,188.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,821.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,958.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,147.20
|
| Rate for Payer: Multiplan Commercial |
$3,824.00
|
| Rate for Payer: Networks By Design Commercial |
$3,107.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,063.00
|
|
