|
HC INTRAVASC LITHO FEM AND POP VASC SAME ARTERY
|
Facility
|
IP
|
$17,142.00
|
|
|
Service Code
|
CPT 37279
|
| Hospital Charge Code |
906811845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,428.40 |
| Max. Negotiated Rate |
$15,427.80 |
| Rate for Payer: Adventist Health Commercial |
$3,428.40
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,713.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,999.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,856.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,856.80
|
| Rate for Payer: Galaxy Health WC |
$14,570.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,285.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,427.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,885.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,113.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,428.40
|
| Rate for Payer: Multiplan Commercial |
$12,856.50
|
| Rate for Payer: Networks By Design Commercial |
$11,142.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,570.70
|
|
|
HC INTRAVASC LITHO IVT SAME ARTERY
|
Facility
|
OP
|
$11,996.00
|
|
|
Service Code
|
CPT 37262
|
| Hospital Charge Code |
906811828
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,399.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,399.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,196.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,597.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,997.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,808.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,978.07
|
| 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 |
$5,398.20
|
| Rate for Payer: Cash Price |
$5,398.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,596.80
|
| Rate for Payer: Cigna of CA HMO |
$7,677.44
|
| Rate for Payer: Cigna of CA PPO |
$8,877.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,196.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,196.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,196.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,397.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,798.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,798.40
|
| Rate for Payer: Galaxy Health WC |
$10,196.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,197.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,796.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,617.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,077.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,399.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,397.20
|
| Rate for Payer: Multiplan Commercial |
$8,997.00
|
| Rate for Payer: Networks By Design Commercial |
$7,797.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,196.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,798.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,197.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,998.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,998.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,998.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,998.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,196.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,196.60
|
| Rate for Payer: Vantage Medical Group Senior |
$10,196.60
|
|
|
HC INTRAVASC LITHO IVT SAME ARTERY
|
Facility
|
IP
|
$11,996.00
|
|
|
Service Code
|
CPT 37262
|
| Hospital Charge Code |
906811828
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,399.20 |
| Max. Negotiated Rate |
$10,796.40 |
| Rate for Payer: Adventist Health Commercial |
$2,399.20
|
| Rate for Payer: Cash Price |
$5,398.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,596.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,397.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,798.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,798.40
|
| Rate for Payer: Galaxy Health WC |
$10,196.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,197.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,796.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,617.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,077.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,399.20
|
| Rate for Payer: Multiplan Commercial |
$8,997.00
|
| Rate for Payer: Networks By Design Commercial |
$7,797.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,196.60
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
IP
|
$12,338.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$11,104.20 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,870.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,636.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,104.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,834.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,279.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.60
|
| Rate for Payer: Multiplan Commercial |
$9,253.50
|
| Rate for Payer: Networks By Design Commercial |
$8,019.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
OP
|
$12,338.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| 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 |
$5,552.10
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,870.40
|
| Rate for Payer: Cigna of CA HMO |
$7,896.32
|
| Rate for Payer: Cigna of CA PPO |
$9,130.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,636.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,104.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,834.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$9,253.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$8,019.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,402.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,169.00
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
IP
|
$24,678.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,935.60 |
| Max. Negotiated Rate |
$22,210.20 |
| Rate for Payer: Adventist Health Commercial |
$4,935.60
|
| Rate for Payer: Cash Price |
$11,105.10
|
| Rate for Payer: Central Health Plan Commercial |
$19,742.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,274.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,871.20
|
| Rate for Payer: Galaxy Health WC |
$20,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,806.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,210.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,670.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,560.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,935.60
|
| Rate for Payer: Multiplan Commercial |
$18,508.50
|
| Rate for Payer: Networks By Design Commercial |
$16,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$20,976.30
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
OP
|
$24,678.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,935.60 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,935.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| 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 |
$11,105.10
|
| Rate for Payer: Cash Price |
$11,105.10
|
| Rate for Payer: Cash Price |
$11,105.10
|
| Rate for Payer: Central Health Plan Commercial |
$19,742.40
|
| Rate for Payer: Cigna of CA HMO |
$15,793.92
|
| Rate for Payer: Cigna of CA PPO |
$18,261.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,274.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$20,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,806.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,210.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,670.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,935.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$18,508.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$16,040.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$20,976.30
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,806.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
OP
|
$24,678.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,935.60 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,935.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| 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 |
$11,105.10
|
| Rate for Payer: Cash Price |
$11,105.10
|
| Rate for Payer: Cash Price |
$11,105.10
|
| Rate for Payer: Central Health Plan Commercial |
$19,742.40
|
| Rate for Payer: Cigna of CA HMO |
$15,793.92
|
| Rate for Payer: Cigna of CA PPO |
$18,261.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,274.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$20,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,806.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,210.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,670.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,935.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$18,508.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$16,040.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$20,976.30
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,806.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
IP
|
$24,678.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,935.60 |
| Max. Negotiated Rate |
$22,210.20 |
| Rate for Payer: Adventist Health Commercial |
$4,935.60
|
| Rate for Payer: Cash Price |
$11,105.10
|
| Rate for Payer: Central Health Plan Commercial |
$19,742.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,274.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,871.20
|
| Rate for Payer: Galaxy Health WC |
$20,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,806.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,210.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,670.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,560.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,935.60
|
| Rate for Payer: Multiplan Commercial |
$18,508.50
|
| Rate for Payer: Networks By Design Commercial |
$16,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$20,976.30
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
OP
|
$7,321.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,464.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,464.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,222.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,026.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,490.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,544.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,258.63
|
| 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 |
$3,294.45
|
| Rate for Payer: Cash Price |
$3,294.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,856.80
|
| Rate for Payer: Cigna of CA HMO |
$4,758.65
|
| Rate for Payer: Cigna of CA PPO |
$5,417.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,222.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,222.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,222.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,124.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,928.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,928.40
|
| Rate for Payer: Galaxy Health WC |
$6,222.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,392.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,588.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,648.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,657.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,319.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,464.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,124.70
|
| Rate for Payer: Multiplan Commercial |
$5,490.75
|
| Rate for Payer: Networks By Design Commercial |
$4,758.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,222.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,928.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,392.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,392.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,660.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,660.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,660.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,660.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,222.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,222.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,222.85
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
IP
|
$7,321.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,464.20 |
| Max. Negotiated Rate |
$6,588.90 |
| Rate for Payer: Adventist Health Commercial |
$1,464.20
|
| Rate for Payer: Cash Price |
$3,294.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,856.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,124.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,928.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,928.40
|
| Rate for Payer: Galaxy Health WC |
$6,222.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,392.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,588.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,648.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,319.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,464.20
|
| Rate for Payer: Multiplan Commercial |
$5,490.75
|
| Rate for Payer: Networks By Design Commercial |
$4,758.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,222.85
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$825.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$534.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$728.25
|
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| Rate for Payer: Cigna of CA HMO |
$621.44
|
| Rate for Payer: Cigna of CA PPO |
$718.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$825.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$825.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$825.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$679.70
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
| Rate for Payer: Riverside University Health System MISP |
$388.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$485.50
|
| 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 |
$825.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$825.35
|
| Rate for Payer: Vantage Medical Group Senior |
$825.35
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.20 |
| Max. Negotiated Rate |
$873.90 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$825.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$534.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$728.25
|
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| Rate for Payer: Cigna of CA HMO |
$621.44
|
| Rate for Payer: Cigna of CA PPO |
$718.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$825.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$825.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$825.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,238.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,472.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$679.70
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
| Rate for Payer: Riverside University Health System MISP |
$388.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$485.50
|
| 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 |
$825.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$825.35
|
| Rate for Payer: Vantage Medical Group Senior |
$825.35
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.20 |
| Max. Negotiated Rate |
$873.90 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
OP
|
$3,551.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.01 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,018.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,953.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,663.25
|
| 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 |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,840.80
|
| Rate for Payer: Cigna of CA HMO |
$2,272.64
|
| Rate for Payer: Cigna of CA PPO |
$2,627.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,018.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,018.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,018.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,485.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,420.40
|
| Rate for Payer: Galaxy Health WC |
$3,018.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,195.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$324.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,254.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$357.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,095.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,485.70
|
| Rate for Payer: Multiplan Commercial |
$2,663.25
|
| Rate for Payer: Networks By Design Commercial |
$2,308.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,018.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,420.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,130.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,775.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,018.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,018.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,018.35
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
IP
|
$3,551.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$710.20 |
| Max. Negotiated Rate |
$3,195.90 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,840.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,485.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,420.40
|
| Rate for Payer: Galaxy Health WC |
$3,018.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,195.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,254.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,095.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.20
|
| Rate for Payer: Multiplan Commercial |
$2,663.25
|
| Rate for Payer: Networks By Design Commercial |
$2,308.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,018.35
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$864.00
|
| Rate for Payer: Cigna of CA PPO |
$999.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,147.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$320.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: Riverside University Health System MISP |
$540.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.00
|
| 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 |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
OP
|
$1,823.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.27 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$364.60
|
| 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 |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| 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 |
$407.27
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,458.40
|
| Rate for Payer: Cigna of CA HMO |
$1,166.72
|
| Rate for Payer: Cigna of CA PPO |
$1,349.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,276.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.05
|
| Rate for Payer: EPIC Health Plan Senior |
$286.03
|
| Rate for Payer: Galaxy Health WC |
$1,549.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,640.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$426.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,157.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$1,367.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$1,184.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$260.03
|
| Rate for Payer: Preferred Health Network WC |
$415.58
|
| Rate for Payer: Prime Health Services Commercial |
$1,549.55
|
| Rate for Payer: Prime Health Services Medicare |
$275.63
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Riverside University Health System MISP |
$286.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,093.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$911.50
|
| Rate for Payer: United Healthcare All Other HMO |
$911.50
|
| Rate for Payer: United Healthcare HMO Rider |
$911.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$911.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
IP
|
$1,823.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.60 |
| Max. Negotiated Rate |
$1,640.70 |
| Rate for Payer: Adventist Health Commercial |
$364.60
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,458.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,276.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.20
|
| Rate for Payer: EPIC Health Plan Senior |
$729.20
|
| Rate for Payer: Galaxy Health WC |
$1,549.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,640.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,157.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,075.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.60
|
| Rate for Payer: Multiplan Commercial |
$1,367.25
|
| Rate for Payer: Networks By Design Commercial |
$1,184.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,549.55
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$390.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$390.40
|
| 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 |
$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 |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,561.60
|
| Rate for Payer: Cigna of CA HMO |
$1,249.28
|
| Rate for Payer: Cigna of CA PPO |
$1,444.48
|
| 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 |
$1,366.40
|
| 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 |
$1,659.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,171.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,756.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$891.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,239.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$984.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$1,464.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$1,268.80
|
| 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 |
$1,659.20
|
| 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 |
$1,171.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$976.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| 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 INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$390.40 |
| Max. Negotiated Rate |
$1,756.80 |
| Rate for Payer: Adventist Health Commercial |
$390.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,561.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,366.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.80
|
| Rate for Payer: EPIC Health Plan Senior |
$780.80
|
| Rate for Payer: Galaxy Health WC |
$1,659.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,171.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,756.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,239.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,151.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.40
|
| Rate for Payer: Multiplan Commercial |
$1,464.00
|
| Rate for Payer: Networks By Design Commercial |
$1,268.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,659.20
|
|
|
HC INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$302.08
|
| Rate for Payer: Cigna of CA PPO |
$349.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: Riverside University Health System MISP |
$188.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.00
|
| 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 |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
|
