|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
IP
|
$29,033.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906820313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,806.60 |
| Max. Negotiated Rate |
$26,129.70 |
| Rate for Payer: Adventist Health Commercial |
$5,806.60
|
| Rate for Payer: Cash Price |
$15,968.15
|
| Rate for Payer: Central Health Plan Commercial |
$23,226.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,613.20
|
| Rate for Payer: Galaxy Health WC |
$24,678.05
|
| Rate for Payer: Global Benefits Group Commercial |
$17,419.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,129.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,365.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,061.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,971.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,806.60
|
| Rate for Payer: Multiplan Commercial |
$21,774.75
|
| Rate for Payer: Networks By Design Commercial |
$18,871.45
|
| Rate for Payer: Prime Health Services Commercial |
$24,678.05
|
|
|
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 |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,949.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,493.39
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$13,572.90
|
| Rate for Payer: Cash Price |
$13,572.90
|
| Rate for Payer: Cash Price |
$13,572.90
|
| 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 |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$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 |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,460.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,935.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$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 |
$22,815.81
|
| 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 |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,806.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC 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 |
$4,299.62
|
| 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 |
$4,026.55
|
| Rate for Payer: Cash Price |
$4,026.55
|
| 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: 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: InnovAge PACE Commercial |
$3,660.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,789.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,531.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,464.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,124.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$4,026.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,856.80
|
| 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 Permanente of CA Commercial/Self Funded |
$4,883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,789.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,531.70
|
| 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
|
IP
|
$869.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.80
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
|
|
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 |
$534.05
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| 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 Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.05
|
| 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 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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$470.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$570.27
|
| 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 |
$534.05
|
| Rate for Payer: Cash Price |
$534.05
|
| Rate for Payer: Cash Price |
$534.05
|
| 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: 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: InnovAge PACE Commercial |
$485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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
|
OP
|
$869.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$510.36
|
| 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 |
$477.95
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: Cigna of CA HMO |
$556.16
|
| Rate for Payer: Cigna of CA PPO |
$643.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.19
|
| Rate for Payer: InnovAge PACE Commercial |
$434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Riverside University Health System MISP |
$347.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$470.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$570.27
|
| 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 |
$534.05
|
| Rate for Payer: Cash Price |
$534.05
|
| Rate for Payer: Cash Price |
$534.05
|
| 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: 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: InnovAge PACE Commercial |
$485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,472.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 |
$534.05
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| 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 Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.05
|
| 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 |
$1,719.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,085.50
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,953.05
|
| Rate for Payer: Cash Price |
$1,953.05
|
| Rate for Payer: Cash Price |
$1,953.05
|
| 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: 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: InnovAge PACE Commercial |
$1,775.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,368.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,198.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,485.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$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: 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 |
$1,953.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,840.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,368.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,352.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,198.07
|
| 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 |
$742.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| 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 Permanente of CA Commercial/Self Funded |
$900.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.65
|
| 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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$653.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$792.86
|
| 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 |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| 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: 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: InnovAge PACE Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$900.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$945.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$317.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$873.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$768.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$932.63
|
| 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 |
$873.40
|
| Rate for Payer: Cash Price |
$873.40
|
| Rate for Payer: Cash Price |
$873.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,016.32
|
| Rate for Payer: Cigna of CA PPO |
$1,175.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,349.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,349.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Senior |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,429.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$320.18
|
| Rate for Payer: InnovAge PACE Commercial |
$794.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$982.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,111.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,111.60
|
| Rate for Payer: Multiplan Commercial |
$1,191.00
|
| Rate for Payer: Networks By Design Commercial |
$1,032.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
| Rate for Payer: Riverside University Health System MISP |
$635.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$952.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,349.80
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$1,429.20 |
| Rate for Payer: Adventist Health Commercial |
$317.60
|
| Rate for Payer: Cash Price |
$873.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,270.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Senior |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,429.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$982.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.60
|
| Rate for Payer: Multiplan Commercial |
$1,191.00
|
| Rate for Payer: Networks By Design Commercial |
$1,032.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
|
|
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 |
$2,696.00 |
| 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 |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| 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 |
$407.27
|
| Rate for Payer: Cash Price |
$1,002.65
|
| Rate for Payer: Cash Price |
$1,002.65
|
| Rate for Payer: Cash Price |
$1,002.65
|
| Rate for Payer: Cash Price |
$1,002.65
|
| 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 |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| 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 |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: InnovAge PACE Commercial |
$383.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$342.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| 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 |
$255.61
|
| 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 |
$270.95
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Riverside University Health System MISP |
$281.17
|
| 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 |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
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 |
$1,002.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,458.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,215.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,128.44
|
| 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 |
$11,238.00 |
| Rate for Payer: Adventist Health Commercial |
$390.40
|
| 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 |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Cash Price |
$1,073.60
|
| 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 |
$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 |
$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 |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$891.37
|
| 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 |
$1,301.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.40
|
| 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 |
$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 |
$1,973.80
|
| 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 |
$2,092.23
|
| 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 |
$1,171.20
|
| 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 INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$459.40 |
| Max. Negotiated Rate |
$2,067.30 |
| Rate for Payer: Adventist Health Commercial |
$459.40
|
| Rate for Payer: Cash Price |
$1,263.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,837.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$918.80
|
| Rate for Payer: Galaxy Health WC |
$1,952.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,378.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,067.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$875.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,421.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.40
|
| Rate for Payer: Multiplan Commercial |
$1,722.75
|
| Rate for Payer: Networks By Design Commercial |
$1,493.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,952.45
|
|
|
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 |
$1,073.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,561.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,301.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,208.29
|
| 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 DIALYSIS CIRCUIT
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$459.40 |
| Max. Negotiated Rate |
$11,238.00 |
| Rate for Payer: Adventist Health Commercial |
$459.40
|
| 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 |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$1,263.35
|
| Rate for Payer: Cash Price |
$1,263.35
|
| Rate for Payer: Cash Price |
$1,263.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,837.60
|
| Rate for Payer: Cigna of CA HMO |
$1,470.08
|
| Rate for Payer: Cigna of CA PPO |
$1,699.78
|
| 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 |
$1,952.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,378.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,067.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$891.37
|
| 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 |
$1,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.40
|
| 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 |
$1,722.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$1,493.05
|
| 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 |
$1,952.45
|
| 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 |
$1,378.20
|
| 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 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 |
$259.60
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| 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 Permanente of CA Commercial/Self Funded |
$314.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.17
|
| 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
|
|
|
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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$228.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.21
|
| 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 |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| 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: 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: InnovAge PACE Commercial |
$236.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$991.80 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Central Health Plan Commercial |
$881.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Senior |
$440.80
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$991.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$826.50
|
| Rate for Payer: Networks By Design Commercial |
$716.30
|
| Rate for Payer: Prime Health Services Commercial |
$936.70
|
|
