|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$823.00
|
| Rate for Payer: United Healthcare All Other HMO |
$823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$823.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$823.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$823.00
|
| 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: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,152.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,045.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$907.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,770.40
|
| Rate for Payer: Cigna of CA HMO |
$1,416.32
|
| Rate for Payer: Cigna of CA PPO |
$1,637.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,549.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,991.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,405.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,327.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,327.80
|
| 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: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$442.60 |
| Max. Negotiated Rate |
$1,991.70 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,770.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,549.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.20
|
| Rate for Payer: EPIC Health Plan Senior |
$885.20
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,991.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,405.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,305.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.60
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$442.60 |
| Max. Negotiated Rate |
$1,991.70 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,770.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,549.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.20
|
| Rate for Payer: EPIC Health Plan Senior |
$885.20
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,991.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,405.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,305.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.60
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,394.19
|
| Rate for Payer: Blue Shield of California EPN |
$878.56
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,770.40
|
| Rate for Payer: Cigna of CA HMO |
$1,416.32
|
| Rate for Payer: Cigna of CA PPO |
$1,637.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,549.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$1,881.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,327.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,991.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,405.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
| Rate for Payer: Networks By Design Commercial |
$1,438.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.05
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,327.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,327.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,106.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,106.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,106.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$494.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Riverside University Health System MISP |
$205.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| 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 |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$289.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$323.82
|
| Rate for Payer: Blue Shield of California EPN |
$204.06
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$494.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Riverside University Health System MISP |
$205.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC INNER CANNULA
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC INNER CANNULA
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.96
|
| Rate for Payer: Blue Shield of California Commercial |
$15.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.58
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
OP
|
$10,884.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.92 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,176.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,897.80
|
| Rate for Payer: Cash Price |
$4,897.80
|
| Rate for Payer: Cash Price |
$4,897.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,707.20
|
| Rate for Payer: Cigna of CA HMO |
$6,965.76
|
| Rate for Payer: Cigna of CA PPO |
$8,054.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,618.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,251.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,530.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,795.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,911.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,176.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,163.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,074.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$9,251.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,530.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,442.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
IP
|
$10,884.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,176.80 |
| Max. Negotiated Rate |
$9,795.60 |
| Rate for Payer: Adventist Health Commercial |
$2,176.80
|
| Rate for Payer: Cash Price |
$4,897.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,707.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,618.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,353.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,353.60
|
| Rate for Payer: Galaxy Health WC |
$9,251.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,530.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,795.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,911.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,421.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,176.80
|
| Rate for Payer: Multiplan Commercial |
$8,163.00
|
| Rate for Payer: Networks By Design Commercial |
$7,074.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,251.40
|
|
|
HC INSERT BRONCHIAL VALVE
|
Facility
|
OP
|
$11,383.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.25 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,276.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,122.35
|
| Rate for Payer: Cash Price |
$5,122.35
|
| Rate for Payer: Cash Price |
$5,122.35
|
| Rate for Payer: Central Health Plan Commercial |
$9,106.40
|
| Rate for Payer: Cigna of CA HMO |
$7,285.12
|
| Rate for Payer: Cigna of CA PPO |
$8,423.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,968.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Galaxy Health WC |
$9,675.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,829.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,244.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,228.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,276.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$8,537.25
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: Networks By Design Commercial |
$7,398.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Commercial |
$9,675.55
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,829.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,691.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
HC INSERT BRONCHIAL VALVE
|
Facility
|
IP
|
$11,383.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,276.60 |
| Max. Negotiated Rate |
$10,244.70 |
| Rate for Payer: Adventist Health Commercial |
$2,276.60
|
| Rate for Payer: Cash Price |
$5,122.35
|
| Rate for Payer: Central Health Plan Commercial |
$9,106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,968.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,553.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,553.20
|
| Rate for Payer: Galaxy Health WC |
$9,675.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,829.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,244.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,228.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,715.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,276.60
|
| Rate for Payer: Multiplan Commercial |
$8,537.25
|
| Rate for Payer: Networks By Design Commercial |
$7,398.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,675.55
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
IP
|
$3,847.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$769.40 |
| Max. Negotiated Rate |
$3,462.30 |
| Rate for Payer: Adventist Health Commercial |
$769.40
|
| Rate for Payer: Cash Price |
$1,731.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,077.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,692.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,538.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,538.80
|
| Rate for Payer: Galaxy Health WC |
$3,269.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,308.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,462.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,442.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,269.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.40
|
| Rate for Payer: Multiplan Commercial |
$2,885.25
|
| Rate for Payer: Networks By Design Commercial |
$2,500.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,269.95
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
OP
|
$3,847.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$624.34 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$769.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,731.15
|
| Rate for Payer: Cash Price |
$1,731.15
|
| Rate for Payer: Cash Price |
$1,731.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,077.60
|
| Rate for Payer: Cigna of CA HMO |
$2,462.08
|
| Rate for Payer: Cigna of CA PPO |
$2,846.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,692.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$3,269.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,308.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,462.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$624.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,442.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$689.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,885.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,500.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$3,269.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,146.11
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,227.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,308.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,923.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
IP
|
$2,182.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.40 |
| Max. Negotiated Rate |
$1,963.80 |
| Rate for Payer: Adventist Health Commercial |
$436.40
|
| Rate for Payer: Cash Price |
$981.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,745.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,527.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$872.80
|
| Rate for Payer: EPIC Health Plan Senior |
$872.80
|
| Rate for Payer: Galaxy Health WC |
$1,854.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,963.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,385.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,287.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.40
|
| Rate for Payer: Multiplan Commercial |
$1,636.50
|
| Rate for Payer: Networks By Design Commercial |
$1,418.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,854.70
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
OP
|
$2,182.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$436.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$981.90
|
| Rate for Payer: Cash Price |
$981.90
|
| Rate for Payer: Cash Price |
$981.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,745.60
|
| Rate for Payer: Cigna of CA HMO |
$1,396.48
|
| Rate for Payer: Cigna of CA PPO |
$1,614.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,527.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$1,854.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,963.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$664.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,385.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$734.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$1,636.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,418.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,854.70
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,309.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906811389
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$218.73
|
| Rate for Payer: Blue Shield of California EPN |
$137.66
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Central Health Plan Commercial |
$276.00
|
| Rate for Payer: Cigna of CA HMO |
$220.80
|
| Rate for Payer: Cigna of CA PPO |
$255.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$241.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$310.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$219.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.50
|
| Rate for Payer: United Healthcare All Other HMO |
$172.50
|
| Rate for Payer: United Healthcare HMO Rider |
$172.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
909001904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Central Health Plan Commercial |
$414.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$466.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.60
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906811389
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Central Health Plan Commercial |
$276.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$241.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: EPIC Health Plan Senior |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$310.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$219.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
