|
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 |
$1,595.70 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$975.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,329.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$809.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$981.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,370.53
|
| Rate for Payer: Blue Shield of California EPN |
$893.59
|
| Rate for Payer: Cash Price |
$975.15
|
| 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: Dignity Health Medi-Cal |
$1,507.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,507.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$709.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$886.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,182.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,097.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,241.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,241.10
|
| 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 System 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 |
$665.41
|
| Rate for Payer: United Healthcare All Other HMO |
$647.68
|
| Rate for Payer: United Healthcare HMO Rider |
$633.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$580.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,507.05
|
|
|
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: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,370.53
|
| Rate for Payer: Blue Shield of California EPN |
$893.59
|
| Rate for Payer: Cash Price |
$975.15
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$675.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,097.49
|
| 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: United Healthcare All Other Commercial |
$665.41
|
| Rate for Payer: United Healthcare All Other HMO |
$647.68
|
| Rate for Payer: United Healthcare HMO Rider |
$633.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$580.66
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$816.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$720.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$464.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$563.81
|
| 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 |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Central Health Plan Commercial |
$768.00
|
| Rate for Payer: Cigna of CA HMO |
$614.40
|
| Rate for Payer: Cigna of CA PPO |
$710.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$816.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$816.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.00
|
| Rate for Payer: EPIC Health Plan Senior |
$384.00
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.94
|
| Rate for Payer: InnovAge PACE Commercial |
$480.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$594.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$672.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
| Rate for Payer: Riverside University Health System MISP |
$384.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$816.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$816.00
|
| Rate for Payer: Vantage Medical Group Senior |
$816.00
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Central Health Plan Commercial |
$768.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.00
|
| Rate for Payer: EPIC Health Plan Senior |
$384.00
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$594.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$17,742.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,548.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| 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 |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$9,758.10
|
| Rate for Payer: Cash Price |
$9,758.10
|
| Rate for Payer: Cash Price |
$9,758.10
|
| Rate for Payer: Central Health Plan Commercial |
$14,193.60
|
| Rate for Payer: Cigna of CA HMO |
$11,354.88
|
| Rate for Payer: Cigna of CA PPO |
$13,129.08
|
| 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 |
$15,080.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,645.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,967.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,412.69
|
| 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 |
$11,833.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,874.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,548.40
|
| 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 |
$13,306.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$11,532.30
|
| 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 |
$15,080.70
|
| 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 |
$10,645.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$17,742.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,548.40 |
| Max. Negotiated Rate |
$15,967.80 |
| Rate for Payer: Adventist Health Commercial |
$3,548.40
|
| Rate for Payer: Cash Price |
$9,758.10
|
| Rate for Payer: Central Health Plan Commercial |
$14,193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,096.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,096.80
|
| Rate for Payer: Galaxy Health WC |
$15,080.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,645.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,967.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,833.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,759.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,982.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,548.40
|
| Rate for Payer: Multiplan Commercial |
$13,306.50
|
| Rate for Payer: Networks By Design Commercial |
$11,532.30
|
| Rate for Payer: Prime Health Services Commercial |
$15,080.70
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$15,428.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,085.60 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,085.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| 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 |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Central Health Plan Commercial |
$12,342.40
|
| Rate for Payer: Cigna of CA HMO |
$9,873.92
|
| Rate for Payer: Cigna of CA PPO |
$11,416.72
|
| 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 |
$13,113.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,885.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,412.69
|
| 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 |
$10,290.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,874.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,085.60
|
| 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 |
$11,571.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$10,028.20
|
| 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 |
$13,113.80
|
| 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 |
$9,256.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$15,428.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,085.60 |
| Max. Negotiated Rate |
$13,885.20 |
| Rate for Payer: Adventist Health Commercial |
$3,085.60
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Central Health Plan Commercial |
$12,342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,171.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,171.20
|
| Rate for Payer: Galaxy Health WC |
$13,113.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,885.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,290.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,878.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,549.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,085.60
|
| Rate for Payer: Multiplan Commercial |
$11,571.00
|
| Rate for Payer: Networks By Design Commercial |
$10,028.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,113.80
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
IP
|
$19,760.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,952.00 |
| Max. Negotiated Rate |
$17,784.00 |
| Rate for Payer: Adventist Health Commercial |
$3,952.00
|
| Rate for Payer: Cash Price |
$10,868.00
|
| Rate for Payer: Central Health Plan Commercial |
$15,808.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,904.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,904.00
|
| Rate for Payer: Galaxy Health WC |
$16,796.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,856.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,784.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,179.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,528.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,231.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,952.00
|
| Rate for Payer: Multiplan Commercial |
$14,820.00
|
| Rate for Payer: Networks By Design Commercial |
$12,844.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,796.00
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
OP
|
$19,760.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.59 |
| Max. Negotiated Rate |
$26,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3,952.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$10,868.00
|
| Rate for Payer: Cash Price |
$10,868.00
|
| Rate for Payer: Cash Price |
$10,868.00
|
| Rate for Payer: Central Health Plan Commercial |
$15,808.00
|
| Rate for Payer: Cigna of CA HMO |
$12,646.40
|
| Rate for Payer: Cigna of CA PPO |
$14,622.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$16,796.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,856.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,784.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$764.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,179.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,952.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$14,820.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$12,844.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$16,796.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,856.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOUS PORT EXCHANGE
|
Facility
|
OP
|
$10,415.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$785.56 |
| Max. Negotiated Rate |
$9,373.50 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,332.00
|
| Rate for Payer: Cigna of CA HMO |
$6,665.60
|
| Rate for Payer: Cigna of CA PPO |
$7,707.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,373.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,946.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$7,811.25
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$785.56
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
| Rate for Payer: Prime Health Services Medicare |
$832.69
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC VENOUS PORT EXCHANGE
|
Facility
|
IP
|
$10,415.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,083.00 |
| Max. Negotiated Rate |
$9,373.50 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Cash Price |
$5,728.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,332.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,166.00
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,373.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,946.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,968.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,446.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.00
|
| Rate for Payer: Multiplan Commercial |
$7,811.25
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
|
|
HC VENOUS SAMPLING
|
Facility
|
OP
|
$11,533.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$529.33 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$2,306.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,003.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7,000.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,578.60
|
| Rate for Payer: Cash Price |
$6,343.15
|
| Rate for Payer: Cash Price |
$6,343.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,226.40
|
| Rate for Payer: Cigna of CA HMO |
$7,381.12
|
| Rate for Payer: Cigna of CA PPO |
$8,534.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$9,803.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,919.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,379.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,692.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,306.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$8,649.75
|
| Rate for Payer: Networks By Design Commercial |
$7,496.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Prime Health Services Commercial |
$9,803.05
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,919.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,919.80
|
| 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: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VENOUS SAMPLING
|
Facility
|
IP
|
$11,533.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,306.60 |
| Max. Negotiated Rate |
$10,379.70 |
| Rate for Payer: Adventist Health Commercial |
$2,306.60
|
| Rate for Payer: Cash Price |
$6,343.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,226.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,613.20
|
| Rate for Payer: Galaxy Health WC |
$9,803.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,919.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,379.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,692.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,394.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,138.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,306.60
|
| Rate for Payer: Multiplan Commercial |
$8,649.75
|
| Rate for Payer: Networks By Design Commercial |
$7,496.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,803.05
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$232.00 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Central Health Plan Commercial |
$928.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Senior |
$464.00
|
| Rate for Payer: Galaxy Health WC |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$773.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$718.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$162.23 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$704.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$830.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$681.27
|
| Rate for Payer: Blue Shield of California Commercial |
$704.12
|
| Rate for Payer: Blue Shield of California EPN |
$460.52
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Central Health Plan Commercial |
$928.00
|
| Rate for Payer: Cigna of CA HMO |
$742.40
|
| Rate for Payer: Cigna of CA PPO |
$858.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$773.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$696.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$696.00
|
| 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: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC VENOVENOUS COLLATERALS AT ABOVE HEART
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93587
|
| Hospital Charge Code |
906811587
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,447.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,755.44
|
| 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 |
$1,643.95
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,494.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,092.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,195.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS AT ABOVE HEART
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93587
|
| Hospital Charge Code |
906811587
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS BELOW HEART
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93588
|
| Hospital Charge Code |
906811588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,447.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,755.44
|
| 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 |
$1,643.95
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,494.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,092.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,195.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS BELOW HEART
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93588
|
| Hospital Charge Code |
906811588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
IP
|
$10,486.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,097.20 |
| Max. Negotiated Rate |
$9,437.40 |
| Rate for Payer: Adventist Health Commercial |
$2,097.20
|
| Rate for Payer: Cash Price |
$5,767.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,388.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,194.40
|
| Rate for Payer: Galaxy Health WC |
$8,913.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,437.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,994.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,995.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,490.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,097.20
|
| Rate for Payer: Multiplan Commercial |
$7,864.50
|
| Rate for Payer: Networks By Design Commercial |
$6,815.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,913.10
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
OP
|
$10,486.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$9,437.40 |
| Rate for Payer: Adventist Health Commercial |
$2,097.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$839.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,368.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$5,767.30
|
| Rate for Payer: Cash Price |
$5,767.30
|
| Rate for Payer: Cash Price |
$5,767.30
|
| Rate for Payer: Cash Price |
$5,767.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,388.80
|
| Rate for Payer: Cigna of CA HMO |
$6,711.04
|
| Rate for Payer: Cigna of CA PPO |
$7,759.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.99
|
| Rate for Payer: EPIC Health Plan Senior |
$839.99
|
| Rate for Payer: Galaxy Health WC |
$8,913.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,437.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,377.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: InnovAge PACE Commercial |
$1,259.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,994.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,097.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,125.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,125.59
|
| Rate for Payer: Multiplan Commercial |
$7,864.50
|
| Rate for Payer: Networks By Design Commercial |
$6,815.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$839.99
|
| Rate for Payer: Prime Health Services Commercial |
$8,913.10
|
| Rate for Payer: Prime Health Services Medicare |
$890.39
|
| Rate for Payer: Riverside University Health System MISP |
$923.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$839.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
IP
|
$8,787.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,757.40 |
| Max. Negotiated Rate |
$7,908.30 |
| Rate for Payer: Adventist Health Commercial |
$1,757.40
|
| Rate for Payer: Cash Price |
$4,832.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,029.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,514.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,514.80
|
| Rate for Payer: Galaxy Health WC |
$7,468.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,272.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,908.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,860.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,347.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,439.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,757.40
|
| Rate for Payer: Multiplan Commercial |
$6,590.25
|
| Rate for Payer: Networks By Design Commercial |
$5,711.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,468.95
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
OP
|
$8,787.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$7,908.30 |
| Rate for Payer: Adventist Health Commercial |
$1,757.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$839.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,336.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$4,832.85
|
| Rate for Payer: Cash Price |
$4,832.85
|
| Rate for Payer: Cash Price |
$4,832.85
|
| Rate for Payer: Cash Price |
$4,832.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,029.60
|
| Rate for Payer: Cigna of CA HMO |
$5,623.68
|
| Rate for Payer: Cigna of CA PPO |
$6,502.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.99
|
| Rate for Payer: EPIC Health Plan Senior |
$839.99
|
| Rate for Payer: Galaxy Health WC |
$7,468.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,272.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,908.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,377.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: InnovAge PACE Commercial |
$1,259.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,860.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,757.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,125.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,125.59
|
| Rate for Payer: Multiplan Commercial |
$6,590.25
|
| Rate for Payer: Networks By Design Commercial |
$5,711.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$839.99
|
| Rate for Payer: Prime Health Services Commercial |
$7,468.95
|
| Rate for Payer: Prime Health Services Medicare |
$890.39
|
| Rate for Payer: Riverside University Health System MISP |
$923.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,272.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,272.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$839.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$3,642.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$728.40 |
| Max. Negotiated Rate |
$3,277.80 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Cash Price |
$2,003.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,456.80
|
| Rate for Payer: Galaxy Health WC |
$3,095.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,277.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,254.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.40
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: Networks By Design Commercial |
$2,367.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,095.70
|
|
