|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
915356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,202.58 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: Adventist Health Commercial |
$1,505.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,019.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,754.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,156.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,838.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,850.69
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,937.60
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,121.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,121.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,304.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,291.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1,836.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,449.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,531.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,272.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,570.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,570.40
|
| Rate for Payer: Multiplan Commercial |
$2,754.00
|
| Rate for Payer: Networks By Design Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,468.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,203.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,203.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,378.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,312.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,121.20
|
|
|
HC IUD INSERTION
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$1,223.10 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,087.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.60
|
| Rate for Payer: EPIC Health Plan Senior |
$543.60
|
| Rate for Payer: Galaxy Health WC |
$1,155.15
|
| Rate for Payer: Global Benefits Group Commercial |
$815.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,223.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$906.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.80
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
| Rate for Payer: Networks By Design Commercial |
$883.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,155.15
|
|
|
HC IUD INSERTION
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$747.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,019.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$658.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$798.14
|
| Rate for Payer: Blue Shield of California Commercial |
$830.35
|
| Rate for Payer: Blue Shield of California EPN |
$542.24
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,087.20
|
| Rate for Payer: Cigna of CA HMO |
$869.76
|
| Rate for Payer: Cigna of CA PPO |
$1,005.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,155.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,155.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.60
|
| Rate for Payer: EPIC Health Plan Senior |
$543.60
|
| Rate for Payer: Galaxy Health WC |
$1,155.15
|
| Rate for Payer: Global Benefits Group Commercial |
$815.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,223.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.34
|
| Rate for Payer: InnovAge PACE Commercial |
$679.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$906.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$951.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$951.30
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
| Rate for Payer: Networks By Design Commercial |
$883.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,155.15
|
| Rate for Payer: Riverside University Health System MISP |
$543.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$815.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$815.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$679.50
|
| Rate for Payer: United Healthcare All Other HMO |
$679.50
|
| Rate for Payer: United Healthcare HMO Rider |
$679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$679.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,155.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,155.15
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.66 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$462.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.46
|
| Rate for Payer: Blue Shield of California Commercial |
$584.12
|
| Rate for Payer: Blue Shield of California EPN |
$381.44
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$611.84
|
| Rate for Payer: Cigna of CA PPO |
$707.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$478.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$478.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| 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 |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| 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 |
$615.83
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$611.84
|
| Rate for Payer: Cigna of CA PPO |
$707.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$478.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$478.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| 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 |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.46
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Cash Price |
$525.80
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$611.84
|
| Rate for Payer: Cigna of CA PPO |
$707.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$13,054.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.88 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,610.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 |
$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 |
$6,372.03
|
| 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 |
$7,179.70
|
| Rate for Payer: Cash Price |
$7,179.70
|
| Rate for Payer: Cash Price |
$7,179.70
|
| Rate for Payer: Central Health Plan Commercial |
$10,443.20
|
| Rate for Payer: Cigna of CA HMO |
$8,354.56
|
| Rate for Payer: Cigna of CA PPO |
$9,659.96
|
| 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 |
$11,095.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,832.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,748.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.88
|
| 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 |
$8,707.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,610.80
|
| 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 |
$9,790.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,485.10
|
| 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 |
$11,095.90
|
| 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 |
$7,832.40
|
| 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 IVC FILTER REPOSITION
|
Facility
|
IP
|
$11,096.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,219.20 |
| Max. Negotiated Rate |
$9,986.40 |
| Rate for Payer: Adventist Health Commercial |
$2,219.20
|
| Rate for Payer: Cash Price |
$6,102.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,438.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,438.40
|
| Rate for Payer: Galaxy Health WC |
$9,431.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,986.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,401.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,227.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,219.20
|
| Rate for Payer: Multiplan Commercial |
$8,322.00
|
| Rate for Payer: Networks By Design Commercial |
$7,212.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,431.60
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$11,096.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.88 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,219.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 |
$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 |
$6,372.03
|
| 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 |
$6,102.80
|
| Rate for Payer: Cash Price |
$6,102.80
|
| Rate for Payer: Cash Price |
$6,102.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,876.80
|
| Rate for Payer: Cigna of CA HMO |
$7,101.44
|
| Rate for Payer: Cigna of CA PPO |
$8,211.04
|
| 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 |
$9,431.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,986.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.88
|
| 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 |
$7,401.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,219.20
|
| 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 |
$8,322.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,212.40
|
| 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 |
$9,431.60
|
| 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 |
$6,657.60
|
| 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 IVC FILTER REPOSITION
|
Facility
|
IP
|
$13,054.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,610.80 |
| Max. Negotiated Rate |
$11,748.60 |
| Rate for Payer: Adventist Health Commercial |
$2,610.80
|
| Rate for Payer: Cash Price |
$7,179.70
|
| Rate for Payer: Central Health Plan Commercial |
$10,443.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,221.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,221.60
|
| Rate for Payer: Galaxy Health WC |
$11,095.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,832.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,748.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,707.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,973.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,080.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,610.80
|
| Rate for Payer: Multiplan Commercial |
$9,790.50
|
| Rate for Payer: Networks By Design Commercial |
$8,485.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,095.90
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
OP
|
$8,704.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,740.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 |
$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 |
$6,372.03
|
| 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 |
$4,787.20
|
| Rate for Payer: Cash Price |
$4,787.20
|
| Rate for Payer: Cash Price |
$4,787.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,963.20
|
| Rate for Payer: Cigna of CA HMO |
$5,570.56
|
| Rate for Payer: Cigna of CA PPO |
$6,440.96
|
| 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 |
$7,398.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,222.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,833.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.25
|
| 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 |
$5,805.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.80
|
| 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 |
$6,528.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$5,657.60
|
| 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 |
$7,398.40
|
| 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 |
$5,222.40
|
| 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 IVC FILTER RETRIEVAL
|
Facility
|
OP
|
$10,240.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,048.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 |
$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 |
$6,372.03
|
| 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 |
$5,632.00
|
| Rate for Payer: Cash Price |
$5,632.00
|
| Rate for Payer: Cash Price |
$5,632.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,192.00
|
| Rate for Payer: Cigna of CA HMO |
$6,553.60
|
| Rate for Payer: Cigna of CA PPO |
$7,577.60
|
| 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 |
$8,704.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,144.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,216.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.25
|
| 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 |
$6,830.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,048.00
|
| 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 |
$7,680.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,656.00
|
| 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 |
$8,704.00
|
| 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 |
$6,144.00
|
| 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 IVC FILTER RETRIEVAL
|
Facility
|
IP
|
$10,240.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,048.00 |
| Max. Negotiated Rate |
$9,216.00 |
| Rate for Payer: Adventist Health Commercial |
$2,048.00
|
| Rate for Payer: Cash Price |
$5,632.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,192.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,096.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,096.00
|
| Rate for Payer: Galaxy Health WC |
$8,704.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,144.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,216.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,830.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,901.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,338.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,048.00
|
| Rate for Payer: Multiplan Commercial |
$7,680.00
|
| Rate for Payer: Networks By Design Commercial |
$6,656.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,704.00
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
IP
|
$8,704.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,740.80 |
| Max. Negotiated Rate |
$7,833.60 |
| Rate for Payer: Adventist Health Commercial |
$1,740.80
|
| Rate for Payer: Cash Price |
$4,787.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,963.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,481.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,481.60
|
| Rate for Payer: Galaxy Health WC |
$7,398.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,222.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,833.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,805.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,316.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,387.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.80
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
| Rate for Payer: Networks By Design Commercial |
$5,657.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,398.40
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
941000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
942100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
949000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
942100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
949000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
943100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
943100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
941000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
