|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Blue Shield of California Commercial |
$350.94
|
| Rate for Payer: Blue Shield of California EPN |
$228.82
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Central Health Plan Commercial |
$363.20
|
| Rate for Payer: Cigna of CA HMO |
$317.80
|
| Rate for Payer: Cigna of CA PPO |
$317.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$181.60
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: Networks By Design Commercial |
$227.00
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.39
|
| Rate for Payer: United Healthcare All Other HMO |
$165.85
|
| Rate for Payer: United Healthcare HMO Rider |
$162.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.69
|
|
|
HC VARICELLA ADMINISTRATION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
902890228
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC VARICELLA ADMINISTRATION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
902890228
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$12.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.42
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
OP
|
$131.58
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Adventist Health Commercial |
$26.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.03
|
| Rate for Payer: Blue Shield of California Commercial |
$79.87
|
| Rate for Payer: Blue Shield of California EPN |
$52.24
|
| Rate for Payer: Cash Price |
$72.37
|
| Rate for Payer: Cash Price |
$72.37
|
| Rate for Payer: Central Health Plan Commercial |
$105.26
|
| Rate for Payer: Cigna of CA HMO |
$84.21
|
| Rate for Payer: Cigna of CA PPO |
$97.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$111.84
|
| Rate for Payer: Global Benefits Group Commercial |
$78.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: InnovAge PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$98.69
|
| Rate for Payer: Networks By Design Commercial |
$85.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$111.84
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
IP
|
$131.58
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Adventist Health Commercial |
$26.32
|
| Rate for Payer: Cash Price |
$72.37
|
| Rate for Payer: Central Health Plan Commercial |
$105.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.63
|
| Rate for Payer: EPIC Health Plan Senior |
$52.63
|
| Rate for Payer: Galaxy Health WC |
$111.84
|
| Rate for Payer: Global Benefits Group Commercial |
$78.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.32
|
| Rate for Payer: Multiplan Commercial |
$98.69
|
| Rate for Payer: Networks By Design Commercial |
$85.53
|
| Rate for Payer: Prime Health Services Commercial |
$111.84
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
915352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.02
|
| Rate for Payer: Blue Shield of California Commercial |
$181.66
|
| Rate for Payer: Blue Shield of California EPN |
$118.44
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.48
|
| Rate for Payer: InnovAge PACE Commercial |
$117.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Riverside University Health System MISP |
$94.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
905352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Blue Shield of California Commercial |
$181.66
|
| Rate for Payer: Blue Shield of California EPN |
$118.44
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
915352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Blue Shield of California Commercial |
$181.66
|
| Rate for Payer: Blue Shield of California EPN |
$118.44
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
905352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.02
|
| Rate for Payer: Blue Shield of California Commercial |
$181.66
|
| Rate for Payer: Blue Shield of California EPN |
$118.44
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.48
|
| Rate for Payer: InnovAge PACE Commercial |
$117.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Riverside University Health System MISP |
$94.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
|
OP
|
$44,324.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,461.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,031.49
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$24,378.20
|
| Rate for Payer: Cash Price |
$24,378.20
|
| Rate for Payer: Cash Price |
$24,378.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,459.20
|
| Rate for Payer: Cigna of CA HMO |
$28,367.36
|
| Rate for Payer: Cigna of CA PPO |
$32,799.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$37,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,891.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$877.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,564.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$969.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,864.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$28,810.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$37,675.40
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,594.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
|
IP
|
$44,324.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,864.80 |
| Max. Negotiated Rate |
$39,891.60 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Cash Price |
$24,378.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,459.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,729.60
|
| Rate for Payer: Galaxy Health WC |
$37,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,891.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,564.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,887.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,436.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,864.80
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
| Rate for Payer: Networks By Design Commercial |
$28,810.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,675.40
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
OP
|
$50,530.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906820007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$10,106.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,466.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,676.27
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$27,791.50
|
| Rate for Payer: Cash Price |
$27,791.50
|
| Rate for Payer: Cash Price |
$27,791.50
|
| Rate for Payer: Central Health Plan Commercial |
$40,424.00
|
| Rate for Payer: Cigna of CA HMO |
$32,339.20
|
| Rate for Payer: Cigna of CA PPO |
$37,392.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$42,950.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30,318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,477.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$736.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,703.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,106.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$37,897.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$32,844.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$42,950.50
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
IP
|
$50,530.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906820007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,106.00 |
| Max. Negotiated Rate |
$45,477.00 |
| Rate for Payer: Adventist Health Commercial |
$10,106.00
|
| Rate for Payer: Cash Price |
$27,791.50
|
| Rate for Payer: Central Health Plan Commercial |
$40,424.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,212.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,212.00
|
| Rate for Payer: Galaxy Health WC |
$42,950.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30,318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,703.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,251.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,278.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,106.00
|
| Rate for Payer: Multiplan Commercial |
$37,897.50
|
| Rate for Payer: Networks By Design Commercial |
$32,844.50
|
| Rate for Payer: Prime Health Services Commercial |
$42,950.50
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
IP
|
$50,530.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906811476
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,106.00 |
| Max. Negotiated Rate |
$45,477.00 |
| Rate for Payer: Adventist Health Commercial |
$10,106.00
|
| Rate for Payer: Cash Price |
$27,791.50
|
| Rate for Payer: Central Health Plan Commercial |
$40,424.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,212.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,212.00
|
| Rate for Payer: Galaxy Health WC |
$42,950.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30,318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,703.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,251.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,278.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,106.00
|
| Rate for Payer: Multiplan Commercial |
$37,897.50
|
| Rate for Payer: Networks By Design Commercial |
$32,844.50
|
| Rate for Payer: Prime Health Services Commercial |
$42,950.50
|
|
|
HC VASC EMBOL OCC ARTERIAL
|
Facility
|
OP
|
$50,530.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
906811476
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$10,106.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,466.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,676.27
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$27,791.50
|
| Rate for Payer: Cash Price |
$27,791.50
|
| Rate for Payer: Cash Price |
$27,791.50
|
| Rate for Payer: Central Health Plan Commercial |
$40,424.00
|
| Rate for Payer: Cigna of CA HMO |
$32,339.20
|
| Rate for Payer: Cigna of CA PPO |
$37,392.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$42,950.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30,318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,477.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$736.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,703.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,106.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$37,897.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$32,844.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$42,950.50
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC VASC EMBOL OCC ART VEN HEM LYM EXTRVST
|
Facility
|
IP
|
$55,851.00
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
906811477
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,170.20 |
| Max. Negotiated Rate |
$50,265.90 |
| Rate for Payer: Adventist Health Commercial |
$11,170.20
|
| Rate for Payer: Cash Price |
$30,718.05
|
| Rate for Payer: Central Health Plan Commercial |
$44,680.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22,340.40
|
| Rate for Payer: Galaxy Health WC |
$47,473.35
|
| Rate for Payer: Global Benefits Group Commercial |
$33,510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50,265.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37,252.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,279.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,571.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,170.20
|
| Rate for Payer: Multiplan Commercial |
$41,888.25
|
| Rate for Payer: Networks By Design Commercial |
$36,303.15
|
| Rate for Payer: Prime Health Services Commercial |
$47,473.35
|
|
|
HC VASC EMBOL OCC ART VEN HEM LYM EXTRVST
|
Facility
|
OP
|
$55,851.00
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
906811477
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$11,170.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,043.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,801.29
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$30,718.05
|
| Rate for Payer: Cash Price |
$30,718.05
|
| Rate for Payer: Cash Price |
$30,718.05
|
| Rate for Payer: Central Health Plan Commercial |
$44,680.80
|
| Rate for Payer: Cigna of CA HMO |
$35,744.64
|
| Rate for Payer: Cigna of CA PPO |
$41,329.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$47,473.35
|
| Rate for Payer: Global Benefits Group Commercial |
$33,510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50,265.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,023.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37,252.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,131.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,170.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$41,888.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$36,303.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$47,473.35
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33,510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VASC EMBOL OCC PX W PRESSURE GEN CATH
|
Facility
|
OP
|
$48,085.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
906811600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$43,276.50 |
| Rate for Payer: Adventist Health Commercial |
$9,617.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,282.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,240.32
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$26,446.75
|
| Rate for Payer: Cash Price |
$26,446.75
|
| Rate for Payer: Cash Price |
$26,446.75
|
| Rate for Payer: Central Health Plan Commercial |
$38,468.00
|
| Rate for Payer: Cigna of CA HMO |
$30,774.40
|
| Rate for Payer: Cigna of CA PPO |
$35,582.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$40,872.25
|
| Rate for Payer: Global Benefits Group Commercial |
$28,851.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,276.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,072.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,617.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$36,063.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,255.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$40,872.25
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,851.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,042.50
|
| Rate for Payer: United Healthcare All Other HMO |
$24,042.50
|
| Rate for Payer: United Healthcare HMO Rider |
$24,042.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24,042.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC VASC EMBOL OCC PX W PRESSURE GEN CATH
|
Facility
|
IP
|
$48,085.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
906811600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,617.00 |
| Max. Negotiated Rate |
$43,276.50 |
| Rate for Payer: Adventist Health Commercial |
$9,617.00
|
| Rate for Payer: Cash Price |
$26,446.75
|
| Rate for Payer: Central Health Plan Commercial |
$38,468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,234.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,234.00
|
| Rate for Payer: Galaxy Health WC |
$40,872.25
|
| Rate for Payer: Global Benefits Group Commercial |
$28,851.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,276.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,072.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,320.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,764.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,617.00
|
| Rate for Payer: Multiplan Commercial |
$36,063.75
|
| Rate for Payer: Networks By Design Commercial |
$31,255.25
|
| Rate for Payer: Prime Health Services Commercial |
$40,872.25
|
|
|
HC VASC EMBOL OCC VENOUS
|
Facility
|
IP
|
$44,324.00
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
906811475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,864.80 |
| Max. Negotiated Rate |
$39,891.60 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Cash Price |
$24,378.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,459.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,729.60
|
| Rate for Payer: Galaxy Health WC |
$37,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,891.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,564.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,887.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,436.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,864.80
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
| Rate for Payer: Networks By Design Commercial |
$28,810.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,675.40
|
|
|
HC VASC EMBOL OCC VENOUS
|
Facility
|
OP
|
$44,324.00
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
906811475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,461.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,031.49
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$24,378.20
|
| Rate for Payer: Cash Price |
$24,378.20
|
| Rate for Payer: Cash Price |
$24,378.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,459.20
|
| Rate for Payer: Cigna of CA HMO |
$28,367.36
|
| Rate for Payer: Cigna of CA PPO |
$32,799.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$37,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,891.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,536.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,564.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,325.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,864.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$28,810.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$37,675.40
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,594.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VASC THROMBIX HEMOSTASIS
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
906812432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC VASC THROMBIX HEMOSTASIS
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
906812432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.89
|
| Rate for Payer: Blue Shield of California Commercial |
$149.69
|
| Rate for Payer: Blue Shield of California EPN |
$97.75
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$208.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: InnovAge PACE Commercial |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$171.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$171.50
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Riverside University Health System MISP |
$98.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.50
|
| Rate for Payer: United Healthcare All Other HMO |
$122.50
|
| Rate for Payer: United Healthcare HMO Rider |
$122.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
|
HC VASCULAR SOLUTIONS VASC BAND
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
906812488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Cash Price |
$88.55
|
| Rate for Payer: Central Health Plan Commercial |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: EPIC Health Plan Senior |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
|
|
HC VASCULAR SOLUTIONS VASC BAND
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
906812488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.56
|
| Rate for Payer: Blue Shield of California Commercial |
$98.37
|
| Rate for Payer: Blue Shield of California EPN |
$64.24
|
| Rate for Payer: Cash Price |
$88.55
|
| Rate for Payer: Central Health Plan Commercial |
$128.80
|
| Rate for Payer: Cigna of CA HMO |
$103.04
|
| Rate for Payer: Cigna of CA PPO |
$119.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: EPIC Health Plan Senior |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.90
|
| Rate for Payer: InnovAge PACE Commercial |
$80.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.70
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
| Rate for Payer: Riverside University Health System MISP |
$64.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.50
|
| Rate for Payer: United Healthcare All Other HMO |
$80.50
|
| Rate for Payer: United Healthcare HMO Rider |
$80.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.85
|
| Rate for Payer: Vantage Medical Group Senior |
$136.85
|
|
