|
HC VENOGRAM SUP SAG SINUS
|
Facility
IP
|
$4,248.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$3,823.20 |
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,398.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,699.20
|
| Rate for Payer: Galaxy Health WC |
$3,610.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,548.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,823.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,833.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.60
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
| Rate for Payer: Networks By Design Commercial |
$2,761.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,610.80
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
OP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$498.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$544.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Central Health Plan Commercial |
$725.60
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$816.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$680.25
|
| Rate for Payer: IEHP medi-cal |
$317.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.40
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$544.20
|
| Rate for Payer: Riverside University Health MISP |
$362.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.95
|
| Rate for Payer: Vantage Medical Group Senior |
$770.95
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
IP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$816.30 |
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Central Health Plan Commercial |
$725.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$816.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.40
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
IP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
906820169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$816.30 |
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Central Health Plan Commercial |
$725.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$816.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.40
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
OP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
906820169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$498.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$544.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Central Health Plan Commercial |
$725.60
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$816.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$680.25
|
| Rate for Payer: IEHP medi-cal |
$317.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.40
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$544.20
|
| Rate for Payer: Riverside University Health MISP |
$362.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.95
|
| Rate for Payer: Vantage Medical Group Senior |
$770.95
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
OP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
906820170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$475.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$307.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$307.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$335.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Central Health Plan Commercial |
$447.20
|
| Rate for Payer: Cigna of CA PPO |
$413.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$503.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$419.25
|
| Rate for Payer: IEHP medi-cal |
$195.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$335.40
|
| Rate for Payer: Riverside University Health MISP |
$223.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$335.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$475.15
|
| Rate for Payer: Vantage Medical Group Senior |
$475.15
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
IP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
906820170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$503.10 |
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Central Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$503.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
IP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$503.10 |
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Central Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$503.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
OP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$475.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$307.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$307.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$335.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Central Health Plan Commercial |
$447.20
|
| Rate for Payer: Cigna of CA PPO |
$413.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$503.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$419.25
|
| Rate for Payer: IEHP medi-cal |
$195.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$335.40
|
| Rate for Payer: Riverside University Health MISP |
$223.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$335.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$475.15
|
| Rate for Payer: Vantage Medical Group Senior |
$475.15
|
|
|
HC VENOUS ACCESS PORT
|
Facility
IP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$1,595.70 |
| Rate for Payer: Blue Shield of California EPN |
$946.78
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,418.40
|
| Rate for Payer: Cigna of CA HMO |
$1,241.10
|
| Rate for Payer: Cigna of CA PPO |
$1,241.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$709.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$709.20
|
| Rate for Payer: Galaxy Health WC |
$1,507.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,063.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,595.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,182.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.60
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,507.05
|
|
|
HC VENOUS ACCESS PORT
|
Facility
OP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$3,733.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,733.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$975.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$975.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$809.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$987.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1,063.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,329.75
|
| Rate for Payer: Blue Shield of California EPN |
$964.51
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,418.40
|
| Rate for Payer: Cigna of CA HMO |
$1,241.10
|
| Rate for Payer: Cigna of CA PPO |
$1,241.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,507.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$709.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$709.20
|
| Rate for Payer: Galaxy Health WC |
$1,507.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,063.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,595.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,329.75
|
| Rate for Payer: IEHP medi-cal |
$620.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,182.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.60
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: Networks By Design Commercial |
$886.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,507.05
|
| Rate for Payer: Riverside University Health MISP |
$709.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,063.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,063.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$886.50
|
| Rate for Payer: United Healthcare All Other HMO |
$886.50
|
| Rate for Payer: United Healthcare HMO Rider |
$886.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$886.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,507.05
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
OP
|
$726.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$617.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$399.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$399.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$435.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Central Health Plan Commercial |
$580.80
|
| Rate for Payer: Cigna of CA PPO |
$537.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$617.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$290.40
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$653.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$544.50
|
| Rate for Payer: IEHP medi-cal |
$254.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$544.50
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$435.60
|
| Rate for Payer: Riverside University Health MISP |
$290.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$617.10
|
| Rate for Payer: Vantage Medical Group Senior |
$617.10
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
IP
|
$726.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$653.40 |
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Central Health Plan Commercial |
$580.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.40
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$653.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$544.50
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
IP
|
$13,416.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,683.20 |
| Max. Negotiated Rate |
$12,074.40 |
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Central Health Plan Commercial |
$10,732.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,366.40
|
| Rate for Payer: Galaxy Health WC |
$11,403.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,049.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,074.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,948.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,683.20
|
| Rate for Payer: Multiplan Commercial |
$10,062.00
|
| Rate for Payer: Networks By Design Commercial |
$8,720.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,403.60
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
OP
|
$13,416.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,683.20 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: BCBS Transplant Transplant |
$8,049.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Central Health Plan Commercial |
$10,732.80
|
| Rate for Payer: Cigna of CA PPO |
$9,927.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$11,403.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,049.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,074.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,062.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: IEHP medi-cal |
$22,679.61
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Innovage PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,948.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,683.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$10,062.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$8,720.40
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$11,403.60
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,049.60
|
| Rate for Payer: Riverside University Health MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,049.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
IP
|
$13,416.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,683.20 |
| Max. Negotiated Rate |
$12,074.40 |
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Central Health Plan Commercial |
$10,732.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,366.40
|
| Rate for Payer: Galaxy Health WC |
$11,403.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,049.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,074.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,948.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,683.20
|
| Rate for Payer: Multiplan Commercial |
$10,062.00
|
| Rate for Payer: Networks By Design Commercial |
$8,720.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,403.60
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
OP
|
$13,416.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,683.20 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: BCBS Transplant Transplant |
$8,049.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Central Health Plan Commercial |
$10,732.80
|
| Rate for Payer: Cigna of CA PPO |
$9,927.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$11,403.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,049.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,074.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,062.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: IEHP medi-cal |
$22,679.61
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Innovage PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,948.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,683.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$10,062.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$8,720.40
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$11,403.60
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,049.60
|
| Rate for Payer: Riverside University Health MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,049.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
OP
|
$14,942.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,988.40 |
| Max. Negotiated Rate |
$26,109.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,965.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$6,723.90
|
| Rate for Payer: Cash Price |
$6,723.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,953.60
|
| Rate for Payer: Cigna of CA PPO |
$11,057.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$12,700.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,965.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,447.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,206.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,966.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,988.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$11,206.50
|
| Rate for Payer: Networks By Design Commercial |
$9,712.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,700.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,965.20
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,965.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
IP
|
$14,942.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,988.40 |
| Max. Negotiated Rate |
$13,447.80 |
| Rate for Payer: Cash Price |
$6,723.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,953.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,976.80
|
| Rate for Payer: Galaxy Health WC |
$12,700.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,965.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,447.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,966.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,988.40
|
| Rate for Payer: Multiplan Commercial |
$11,206.50
|
| Rate for Payer: Networks By Design Commercial |
$9,712.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,700.70
|
|
|
HC VENOUS SAMPLING
|
Facility
IP
|
$11,798.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,359.60 |
| Max. Negotiated Rate |
$10,618.20 |
| Rate for Payer: Cash Price |
$5,309.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,438.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,719.20
|
| Rate for Payer: Galaxy Health WC |
$10,028.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,078.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,618.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,869.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,359.60
|
| Rate for Payer: Multiplan Commercial |
$8,848.50
|
| Rate for Payer: Networks By Design Commercial |
$7,668.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,028.30
|
|
|
HC VENOUS SAMPLING
|
Facility
OP
|
$11,798.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$856.73 |
| Max. Negotiated Rate |
$11,329.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$856.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.33
|
| Rate for Payer: BCBS Transplant Transplant |
$7,078.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,291.16
|
| Rate for Payer: Blue Shield of California EPN |
$5,733.83
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$5,309.10
|
| Rate for Payer: Cash Price |
$5,309.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,438.40
|
| Rate for Payer: Cigna of CA HMO |
$7,550.72
|
| Rate for Payer: Cigna of CA PPO |
$8,730.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$10,028.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,078.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,618.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,848.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: IEHP medi-cal |
$11,329.02
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Innovage PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,869.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,359.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$8,848.50
|
| Rate for Payer: Networks By Design Commercial |
$7,668.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,028.30
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,078.80
|
| Rate for Payer: Riverside University Health MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,078.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,078.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
OP
|
$1,437.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.40 |
| Max. Negotiated Rate |
$1,293.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$860.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$830.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$848.98
|
| Rate for Payer: BCBS Transplant Transplant |
$862.20
|
| Rate for Payer: Blue Shield of California Commercial |
$888.07
|
| Rate for Payer: Blue Shield of California EPN |
$698.38
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,149.60
|
| Rate for Payer: Cigna of CA HMO |
$919.68
|
| Rate for Payer: Cigna of CA PPO |
$1,063.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,293.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,077.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: IEHP medi-cal |
$850.28
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Innovage PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,077.75
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$862.20
|
| Rate for Payer: Riverside University Health MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$862.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$862.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.46
|
| Rate for Payer: United Healthcare All Other HMO |
$396.46
|
| Rate for Payer: United Healthcare HMO Rider |
$396.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
IP
|
$1,437.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.40 |
| Max. Negotiated Rate |
$1,293.30 |
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$574.80
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,293.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.40
|
| Rate for Payer: Multiplan Commercial |
$1,077.75
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
IP
|
$9,598.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,919.60 |
| Max. Negotiated Rate |
$8,638.20 |
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,678.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,839.20
|
| Rate for Payer: Galaxy Health WC |
$8,158.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,758.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,638.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,401.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,919.60
|
| Rate for Payer: Multiplan Commercial |
$7,198.50
|
| Rate for Payer: Networks By Design Commercial |
$6,238.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,158.30
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
OP
|
$9,598.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$8,638.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$782.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,758.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$782.97
|
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Cash Price |
$4,319.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,678.40
|
| Rate for Payer: Cigna of CA HMO |
$6,142.72
|
| Rate for Payer: Cigna of CA PPO |
$7,102.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$782.97
|
| Rate for Payer: Galaxy Health WC |
$8,158.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,758.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,638.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,198.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,284.07
|
| Rate for Payer: IEHP medi-cal |
$1,291.90
|
| Rate for Payer: IEHP Medicare Advantage |
$782.97
|
| Rate for Payer: Innovage PACE Commercial |
$1,174.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,401.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,919.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,049.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,049.18
|
| Rate for Payer: Multiplan Commercial |
$7,198.50
|
| Rate for Payer: Networks By Design Commercial |
$6,238.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,158.30
|
| Rate for Payer: Prime Health Services Medicare |
$829.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,758.80
|
| Rate for Payer: Riverside University Health MISP |
$861.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,758.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,758.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
