|
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 |
$5,986.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,707.20
|
| 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 Permanente of CA Commercial/Self Funded |
$7,259.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,146.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,737.20
|
| 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 INNOMINATE SUBCLAV UNI
|
Facility
|
OP
|
$12,805.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
906820223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.92 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,561.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$7,042.75
|
| Rate for Payer: Cash Price |
$7,042.75
|
| Rate for Payer: Cash Price |
$7,042.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,244.00
|
| Rate for Payer: Cigna of CA HMO |
$8,195.20
|
| Rate for Payer: Cigna of CA PPO |
$9,475.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,884.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,524.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,540.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,561.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,603.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,323.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$10,884.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,683.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC 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 |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,176.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,986.20
|
| Rate for Payer: Cash Price |
$5,986.20
|
| Rate for Payer: Cash Price |
$5,986.20
|
| 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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,259.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,176.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$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 |
$3,999.21
|
| 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 |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,530.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
IP
|
$12,805.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
906820223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,561.00 |
| Max. Negotiated Rate |
$11,524.50 |
| Rate for Payer: Adventist Health Commercial |
$2,561.00
|
| Rate for Payer: Cash Price |
$7,042.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,244.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,122.00
|
| Rate for Payer: Galaxy Health WC |
$10,884.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,524.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,540.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,878.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,926.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,561.00
|
| Rate for Payer: Multiplan Commercial |
$9,603.75
|
| Rate for Payer: Networks By Design Commercial |
$8,323.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,884.25
|
|
|
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 |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,276.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$8,795.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$6,260.65
|
| Rate for Payer: Cash Price |
$6,260.65
|
| Rate for Payer: Cash Price |
$6,260.65
|
| 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 |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,874.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8,795.69
|
| 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 |
$14,424.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: InnovAge PACE Commercial |
$13,193.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,592.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,795.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,276.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,786.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,786.22
|
| 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 |
$8,795.69
|
| 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 |
$9,323.43
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,675.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,829.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,795.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
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 |
$6,260.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,106.40
|
| 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 Permanente of CA Commercial/Self Funded |
$7,592.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,336.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,046.08
|
| 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 INSERT IMPL CONTRACEPTIVE CAPS
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
CPT 11975
|
| Hospital Charge Code |
902890337
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$1,054.80 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Central Health Plan Commercial |
$937.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$468.80
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,054.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$725.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.40
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
|
|
HC INSERT IMPL CONTRACEPTIVE CAPS
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 11975
|
| Hospital Charge Code |
902890337
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$2,582.00 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$711.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$996.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$644.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Blue Shield of California Commercial |
$716.09
|
| Rate for Payer: Blue Shield of California EPN |
$467.63
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Central Health Plan Commercial |
$937.60
|
| Rate for Payer: Cigna of CA HMO |
$750.08
|
| Rate for Payer: Cigna of CA PPO |
$867.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$996.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$996.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$996.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$468.80
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,054.80
|
| Rate for Payer: InnovAge PACE Commercial |
$586.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$725.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$820.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$820.40
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
| Rate for Payer: Riverside University Health System MISP |
$468.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.00
|
| Rate for Payer: United Healthcare All Other HMO |
$586.00
|
| Rate for Payer: United Healthcare HMO Rider |
$586.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$586.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$996.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$996.20
|
| Rate for Payer: Vantage Medical Group Senior |
$996.20
|
|
|
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 |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$769.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,115.85
|
| Rate for Payer: Cash Price |
$2,115.85
|
| Rate for Payer: Cash Price |
$2,115.85
|
| 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 |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| 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: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$624.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,565.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$689.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| 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 |
$1,973.80
|
| 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 |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,308.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| 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 |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
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 |
$2,115.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,077.60
|
| 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 Permanente of CA Commercial/Self Funded |
$2,565.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,465.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,381.29
|
| 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 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 |
$1,200.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,745.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,455.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$831.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,350.66
|
| 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$436.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,200.10
|
| Rate for Payer: Cash Price |
$1,200.10
|
| Rate for Payer: Cash Price |
$1,200.10
|
| 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 |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$664.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,455.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$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 |
$785.56
|
| 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 |
$832.69
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,309.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC 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 |
$284.90
|
| Rate for Payer: Central Health Plan Commercial |
$414.40
|
| 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 Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.64
|
| 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
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906811389
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$167.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.62
|
| Rate for Payer: Blue Shield of California Commercial |
$210.79
|
| Rate for Payer: Blue Shield of California EPN |
$137.66
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: Cash Price |
$189.75
|
| 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 |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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 |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| 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 |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
909001904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$250.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.22
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Central Health Plan Commercial |
$414.40
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906820132
|
|
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 |
$189.75
|
| Rate for Payer: Central Health Plan Commercial |
$276.00
|
| 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 Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.56
|
| 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
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906820132
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$167.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.62
|
| Rate for Payer: Blue Shield of California Commercial |
$210.79
|
| Rate for Payer: Blue Shield of California EPN |
$137.66
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: Cash Price |
$189.75
|
| 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 |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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 |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| 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 |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
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 |
$189.75
|
| Rate for Payer: Central Health Plan Commercial |
$276.00
|
| 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 Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.56
|
| 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
|
|
|
HC INSERT NON-TNEL CV CATH LT 5YR
|
Facility
|
OP
|
$3,760.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
906812249
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$148.56 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,444.00
|
| Rate for Payer: Cigna of CA PPO |
$2,782.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INSERT NON-TNEL CV CATH LT 5YR
|
Facility
|
IP
|
$3,760.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
906812249
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,432.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
|
|
HC INSERT NON-TNEL CV CATH LT 5YR
|
Facility
|
IP
|
$3,958.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
906820087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$791.60 |
| Max. Negotiated Rate |
$3,562.20 |
| Rate for Payer: Adventist Health Commercial |
$791.60
|
| Rate for Payer: Cash Price |
$2,176.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,166.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,583.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,583.20
|
| Rate for Payer: Galaxy Health WC |
$3,364.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,562.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,639.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,508.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$791.60
|
| Rate for Payer: Multiplan Commercial |
$2,968.50
|
| Rate for Payer: Networks By Design Commercial |
$2,572.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,364.30
|
|
|
HC INSERT NON-TNEL CV CATH LT 5YR
|
Facility
|
OP
|
$3,760.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
906812249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: Cigna of CA HMO |
$2,406.40
|
| Rate for Payer: Cigna of CA PPO |
$2,782.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,880.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,880.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,880.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,880.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INSERT NON-TNEL CV CATH LT 5YR
|
Facility
|
IP
|
$3,760.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
906812249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,432.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
|
|
HC INSERT NON-TNEL CV CATH LT 5YR
|
Facility
|
OP
|
$3,958.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
906820087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$148.56 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$791.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,176.90
|
| Rate for Payer: Cash Price |
$2,176.90
|
| Rate for Payer: Cash Price |
$2,176.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,166.40
|
| Rate for Payer: Cigna of CA HMO |
$2,572.70
|
| Rate for Payer: Cigna of CA PPO |
$2,928.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$3,364.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,562.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,639.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$791.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$2,968.50
|
| Rate for Payer: Networks By Design Commercial |
$2,572.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$3,364.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,374.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,374.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INSERT NON-TNNL CV CATH LT 5YR
|
Facility
|
IP
|
$3,760.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
909081358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$752.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,504.00
|
| Rate for Payer: Galaxy Health WC |
$3,196.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,256.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,507.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,432.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,327.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.00
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,196.00
|
|
