|
HC INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,062.60
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,328.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: InnovAge PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Riverside University Health System MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$497.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,062.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,113.96
|
| Rate for Payer: Blue Shield of California EPN |
$866.02
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,328.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$821.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: InnovAge PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Riverside University Health System MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
OP
|
$15,279.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,055.80 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: Blue Distinction Transplant |
$9,167.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Central Health Plan Commercial |
$12,223.20
|
| Rate for Payer: Cigna of CA PPO |
$11,306.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$12,987.15
|
| Rate for Payer: Global Benefits Group Commercial |
$9,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,751.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,459.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,679.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: InnovAge PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$11,459.25
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$9,931.35
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$12,987.15
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Riverside University Health System MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,167.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
IP
|
$15,279.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,055.80 |
| Max. Negotiated Rate |
$13,751.10 |
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Central Health Plan Commercial |
$12,223.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,111.60
|
| Rate for Payer: Galaxy Health WC |
$12,987.15
|
| Rate for Payer: Global Benefits Group Commercial |
$9,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,751.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,821.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.80
|
| Rate for Payer: Multiplan Commercial |
$11,459.25
|
| Rate for Payer: Networks By Design Commercial |
$9,931.35
|
| Rate for Payer: Prime Health Services Commercial |
$12,987.15
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
IP
|
$15,279.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,055.80 |
| Max. Negotiated Rate |
$13,751.10 |
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Central Health Plan Commercial |
$12,223.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,111.60
|
| Rate for Payer: Galaxy Health WC |
$12,987.15
|
| Rate for Payer: Global Benefits Group Commercial |
$9,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,751.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,821.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.80
|
| Rate for Payer: Multiplan Commercial |
$11,459.25
|
| Rate for Payer: Networks By Design Commercial |
$9,931.35
|
| Rate for Payer: Prime Health Services Commercial |
$12,987.15
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
OP
|
$15,279.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,055.80 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: Blue Distinction Transplant |
$9,167.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Central Health Plan Commercial |
$12,223.20
|
| Rate for Payer: Cigna of CA PPO |
$11,306.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$12,987.15
|
| Rate for Payer: Global Benefits Group Commercial |
$9,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,751.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,459.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,679.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: InnovAge PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,191.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$11,459.25
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$9,931.35
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$12,987.15
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Riverside University Health System MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,167.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
OP
|
$30,561.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: Blue Distinction Transplant |
$18,336.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.80
|
| Rate for Payer: Cigna of CA PPO |
$22,615.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$25,976.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22,920.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$19,864.65
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.85
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
IP
|
$30,561.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906820314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,112.20 |
| Max. Negotiated Rate |
$27,504.90 |
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,224.40
|
| Rate for Payer: Galaxy Health WC |
$25,976.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.20
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Networks By Design Commercial |
$19,864.65
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.85
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
OP
|
$30,561.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906820314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: Blue Distinction Transplant |
$18,336.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.80
|
| Rate for Payer: Cigna of CA PPO |
$22,615.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$25,976.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22,920.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$19,864.65
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.85
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
IP
|
$30,561.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,112.20 |
| Max. Negotiated Rate |
$27,504.90 |
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,224.40
|
| Rate for Payer: Galaxy Health WC |
$25,976.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.20
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Networks By Design Commercial |
$19,864.65
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.85
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
OP
|
$30,561.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906820313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: Blue Distinction Transplant |
$18,336.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.80
|
| Rate for Payer: Cigna of CA PPO |
$22,615.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$25,976.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22,920.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$19,864.65
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.85
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
IP
|
$30,561.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,112.20 |
| Max. Negotiated Rate |
$27,504.90 |
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,224.40
|
| Rate for Payer: Galaxy Health WC |
$25,976.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.20
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Networks By Design Commercial |
$19,864.65
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.85
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
OP
|
$30,561.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: Blue Distinction Transplant |
$18,336.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.80
|
| Rate for Payer: Cigna of CA PPO |
$22,615.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$25,976.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22,920.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$19,864.65
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.85
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
IP
|
$30,561.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906820313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,112.20 |
| Max. Negotiated Rate |
$27,504.90 |
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Central Health Plan Commercial |
$24,448.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,224.40
|
| Rate for Payer: Galaxy Health WC |
$25,976.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,504.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,112.20
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Networks By Design Commercial |
$19,864.65
|
| Rate for Payer: Prime Health Services Commercial |
$25,976.85
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$518.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Media |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$648.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Riverside University Health System MISP |
$345.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$518.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Media |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$648.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Riverside University Health System MISP |
$345.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
906820019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$518.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Media |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$648.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,472.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Riverside University Health System MISP |
$345.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$518.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Media |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$648.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,472.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Riverside University Health System MISP |
$345.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
906820019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
IP
|
$2,685.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$2,416.50 |
| Rate for Payer: Cash Price |
$1,208.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,148.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.00
|
| Rate for Payer: Galaxy Health WC |
$2,282.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,611.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,416.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,790.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,022.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.00
|
| Rate for Payer: Multiplan Commercial |
$2,013.75
|
| Rate for Payer: Networks By Design Commercial |
$1,745.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,282.25
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
OP
|
$2,685.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.92 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,202.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,282.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,476.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,611.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$1,208.25
|
| Rate for Payer: Cash Price |
$1,208.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,148.00
|
| Rate for Payer: Cigna of CA PPO |
$1,986.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,282.25
|
| Rate for Payer: Dignity Health Media |
$2,282.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,282.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.00
|
| Rate for Payer: Galaxy Health WC |
$2,282.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,611.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,416.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,013.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$939.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,790.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.00
|
| Rate for Payer: Multiplan Commercial |
$2,013.75
|
| Rate for Payer: Networks By Design Commercial |
$1,745.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,282.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,074.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,611.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,282.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,282.25
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$1,242.90 |
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,242.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.20
|
| Rate for Payer: Multiplan Commercial |
$1,035.75
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
