|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,271.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$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 |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,448.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$5,401.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,035.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$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 |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,448.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,035.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,749.45
|
| 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
|
OP
|
$6,355.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
900501752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.17 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,271.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: 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 |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,448.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$5,401.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,035.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,448.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,035.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,749.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,696.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,539.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,430.16
|
| 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
|
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 |
$1,555.48
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,696.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,539.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$879.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,430.16
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,469.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,141.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$6,243.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,407.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$572.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,664.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$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 |
$3,672.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,141.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,664.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,333.55
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,399.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$6,556.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,628.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$498.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,898.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$563.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$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 |
$3,857.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,399.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,898.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,551.26
|
| 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 BIOP PERCUT BY NEEDLE
|
Facility
|
OP
|
$4,780.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
903800069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.84 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$956.00
|
| Rate for Payer: Adventist Health Commercial |
$87.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cigna of CA HMO |
$279.68
|
| Rate for Payer: Cigna of CA HMO |
$3,059.20
|
| Rate for Payer: Cigna of CA PPO |
$3,537.20
|
| Rate for Payer: Cigna of CA PPO |
$323.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$305.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,346.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,063.00
|
| Rate for Payer: Galaxy Health WC |
$371.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$262.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,035.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$277.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,147.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: Multiplan Commercial |
$3,824.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,107.00
|
| Rate for Payer: Networks By Design Commercial |
$284.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,063.00
|
| Rate for Payer: Prime Health Services Commercial |
$371.45
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,868.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,390.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$218.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,346.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,035.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,820.20
|
| 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
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
|
OP
|
$4,780.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.84 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$956.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cigna of CA HMO |
$3,059.20
|
| Rate for Payer: Cigna of CA PPO |
$3,537.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,346.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$4,063.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,868.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,035.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,147.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,824.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,107.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,063.00
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,868.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
|
IP
|
$4,780.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,346.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,035.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,820.20
|
| 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
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
|
IP
|
$3,755.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$751.00 |
| Max. Negotiated Rate |
$3,191.75 |
| Rate for Payer: Adventist Health Commercial |
$751.00
|
| Rate for Payer: Cash Price |
$1,689.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,628.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,502.00
|
| Rate for Payer: Galaxy Health WC |
$3,191.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,253.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,384.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,215.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$901.20
|
| Rate for Payer: Multiplan Commercial |
$3,004.00
|
| Rate for Payer: Networks By Design Commercial |
$2,440.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,191.75
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
|
OP
|
$3,755.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.84 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$751.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,689.75
|
| Rate for Payer: Cash Price |
$1,689.75
|
| Rate for Payer: Cash Price |
$1,689.75
|
| Rate for Payer: Cigna of CA HMO |
$2,403.20
|
| Rate for Payer: Cigna of CA PPO |
$2,778.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,628.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$3,191.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,253.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,384.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$901.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$3,004.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,440.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,191.75
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,253.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,877.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.60 |
| Max. Negotiated Rate |
$1,201.05 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$989.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.20
|
| Rate for Payer: EPIC Health Plan Senior |
$565.20
|
| Rate for Payer: Galaxy Health WC |
$1,201.05
|
| Rate for Payer: Global Benefits Group Commercial |
$847.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$833.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.12
|
| Rate for Payer: Multiplan Commercial |
$1,130.40
|
| Rate for Payer: Networks By Design Commercial |
$918.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.05
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.71 |
| Max. Negotiated Rate |
$1,657.33 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,657.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$369.82
|
| Rate for Payer: Blue Shield of California Commercial |
$594.87
|
| Rate for Payer: Blue Shield of California Commercial |
$901.49
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cigna of CA HMO |
$904.32
|
| Rate for Payer: Cigna of CA PPO |
$1,045.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$989.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$1,201.05
|
| Rate for Payer: Global Benefits Group Commercial |
$847.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,130.40
|
| Rate for Payer: Networks By Design Commercial |
$918.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$847.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$847.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC RENAL DILATOR SET
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$606.90 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$535.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$432.18
|
| Rate for Payer: Blue Shield of California Commercial |
$362.00
|
| Rate for Payer: Blue Shield of California Commercial |
$549.07
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cigna of CA HMO |
$499.80
|
| Rate for Payer: Cigna of CA PPO |
$499.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$606.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$606.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$499.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.60
|
| Rate for Payer: EPIC Health Plan Senior |
$285.60
|
| Rate for Payer: Galaxy Health WC |
$606.90
|
| Rate for Payer: Global Benefits Group Commercial |
$428.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$453.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$259.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$499.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$499.80
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: Networks By Design Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Commercial |
$606.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$428.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$428.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.96
|
| Rate for Payer: United Healthcare All Other HMO |
$260.82
|
| Rate for Payer: United Healthcare HMO Rider |
$255.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.90
|
| Rate for Payer: Vantage Medical Group Senior |
$606.90
|
|
|
HC RENAL DILATOR SET
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cigna of CA HMO |
$499.80
|
| Rate for Payer: Cigna of CA PPO |
$499.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$499.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.60
|
| Rate for Payer: EPIC Health Plan Senior |
$285.60
|
| Rate for Payer: Galaxy Health WC |
$606.90
|
| Rate for Payer: Global Benefits Group Commercial |
$428.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$453.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.36
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: Networks By Design Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Commercial |
$606.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.96
|
| Rate for Payer: United Healthcare All Other HMO |
$260.82
|
| Rate for Payer: United Healthcare HMO Rider |
$255.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.84
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$476.85 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$224.40
|
| Rate for Payer: Galaxy Health WC |
$476.85
|
| Rate for Payer: Global Benefits Group Commercial |
$336.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.64
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: Networks By Design Commercial |
$364.65
|
| Rate for Payer: Prime Health Services Commercial |
$476.85
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$476.85 |
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: Networks By Design Commercial |
$364.65
|
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.57
|
| Rate for Payer: Blue Shield of California Commercial |
$258.62
|
| Rate for Payer: Blue Shield of California Commercial |
$391.02
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cigna of CA HMO |
$359.04
|
| Rate for Payer: Cigna of CA PPO |
$415.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.32
|
| Rate for Payer: EPIC Health Plan Senior |
$9.55
|
| Rate for Payer: Galaxy Health WC |
$476.85
|
| Rate for Payer: Global Benefits Group Commercial |
$336.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$476.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.03
|
| Rate for Payer: United Healthcare All Other HMO |
$7.03
|
| Rate for Payer: United Healthcare HMO Rider |
$7.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8.68
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
IP
|
$7,345.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,141.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,664.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,333.55
|
| 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 SELECTIVE 2ND ORDER
|
Facility
|
OP
|
$7,345.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.65 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,469.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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 |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,141.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| 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/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$531.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,664.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$601.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,017.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$5,876.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| 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 |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,407.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,672.50
|
| 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 |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
IP
|
$7,714.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,399.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,898.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,551.26
|
| 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
|
|
