|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.20 |
| 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 |
$1,173.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.55
|
| 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 |
$828.60
|
| 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: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,104.80
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Dignity Health Media |
$1,173.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,035.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$483.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.68
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$552.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.60
|
| 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 |
$1,173.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.85
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
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
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.20 |
| 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 |
$1,173.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.55
|
| 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 |
$828.60
|
| 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: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,104.80
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Dignity Health Media |
$1,173.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,035.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$483.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.68
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$552.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.60
|
| 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 |
$1,173.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.85
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| 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 |
$826.80
|
| Rate for Payer: Caremore Medicare Advantage |
$248.97
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,102.40
|
| Rate for Payer: Cigna of CA PPO |
$1,019.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,240.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,033.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$408.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: InnovAge PACE Commercial |
$373.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$1,033.50
|
| Rate for Payer: Networks By Design Commercial |
$895.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
| Rate for Payer: Prime Health Services Medicare |
$263.91
|
| Rate for Payer: Riverside University Health System MISP |
$273.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$826.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$689.00
|
| Rate for Payer: United Healthcare All Other HMO |
$689.00
|
| Rate for Payer: United Healthcare HMO Rider |
$689.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$689.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$1,240.20 |
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,102.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.20
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,240.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.60
|
| Rate for Payer: Multiplan Commercial |
$1,033.50
|
| Rate for Payer: Networks By Design Commercial |
$895.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$9,194.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| 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 |
$1,450.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA PPO |
$1,789.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,813.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,301.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$9,194.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| 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 |
$1,450.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA PPO |
$1,789.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,813.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,301.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.80 |
| 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 |
$496.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.20
|
| 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 |
$350.40
|
| 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 |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Central Health Plan Commercial |
$467.20
|
| Rate for Payer: Cigna of CA PPO |
$432.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.40
|
| Rate for Payer: Dignity Health Media |
$496.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$438.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: Networks By Design Commercial |
$379.60
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
| Rate for Payer: Riverside University Health System MISP |
$233.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.40
|
| 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 |
$496.40
|
| Rate for Payer: Vantage Medical Group Senior |
$496.40
|
|
|
HC INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Central Health Plan Commercial |
$467.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: Networks By Design Commercial |
$379.60
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.60 |
| Max. Negotiated Rate |
$1,015.20 |
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Central Health Plan Commercial |
$902.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.20
|
| Rate for Payer: Galaxy Health WC |
$958.80
|
| Rate for Payer: Global Benefits Group Commercial |
$676.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,015.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$752.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
| Rate for Payer: Networks By Design Commercial |
$733.20
|
| Rate for Payer: Prime Health Services Commercial |
$958.80
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.57 |
| 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 |
$958.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$620.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.40
|
| 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 |
$676.80
|
| 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 |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Central Health Plan Commercial |
$902.40
|
| Rate for Payer: Cigna of CA PPO |
$834.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$958.80
|
| Rate for Payer: Dignity Health Media |
$958.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$958.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$451.20
|
| Rate for Payer: Galaxy Health WC |
$958.80
|
| Rate for Payer: Global Benefits Group Commercial |
$676.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,015.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$846.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$394.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$752.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
| Rate for Payer: Networks By Design Commercial |
$733.20
|
| Rate for Payer: Prime Health Services Commercial |
$958.80
|
| Rate for Payer: Riverside University Health System MISP |
$451.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$676.80
|
| 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 |
$958.80
|
| Rate for Payer: Vantage Medical Group Senior |
$958.80
|
|
|
HC INTRO ET ANGLED 15FR 70CM
|
Facility
|
IP
|
$62.16
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$55.94 |
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Central Health Plan Commercial |
$49.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.86
|
| Rate for Payer: Galaxy Health WC |
$52.84
|
| Rate for Payer: Global Benefits Group Commercial |
$37.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.43
|
| Rate for Payer: Multiplan Commercial |
$46.62
|
| Rate for Payer: Networks By Design Commercial |
$40.40
|
| Rate for Payer: Prime Health Services Commercial |
$52.84
|
|
|
HC INTRO ET ANGLED 15FR 70CM
|
Facility
|
OP
|
$62.16
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.72
|
| Rate for Payer: Blue Distinction Transplant |
$37.30
|
| Rate for Payer: Blue Shield of California Commercial |
$39.10
|
| Rate for Payer: Blue Shield of California EPN |
$30.40
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Central Health Plan Commercial |
$49.73
|
| Rate for Payer: Cigna of CA HMO |
$39.78
|
| Rate for Payer: Cigna of CA PPO |
$46.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.84
|
| Rate for Payer: Dignity Health Media |
$52.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.86
|
| Rate for Payer: Galaxy Health WC |
$52.84
|
| Rate for Payer: Global Benefits Group Commercial |
$37.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$46.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.43
|
| Rate for Payer: Multiplan Commercial |
$46.62
|
| Rate for Payer: Networks By Design Commercial |
$40.40
|
| Rate for Payer: Prime Health Services Commercial |
$52.84
|
| Rate for Payer: Riverside University Health System MISP |
$24.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.08
|
| Rate for Payer: United Healthcare All Other HMO |
$31.08
|
| Rate for Payer: United Healthcare HMO Rider |
$31.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$52.84
|
|
|
HC INTRO ETT 15FR 70CM FLEXGDE
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901691012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.96
|
| Rate for Payer: Blue Distinction Transplant |
$45.66
|
| Rate for Payer: Blue Shield of California Commercial |
$47.87
|
| Rate for Payer: Blue Shield of California EPN |
$37.21
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: Cigna of CA HMO |
$48.70
|
| Rate for Payer: Cigna of CA PPO |
$56.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.68
|
| Rate for Payer: Dignity Health Media |
$64.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.68
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$57.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.46
|
| Rate for Payer: Prime Health Services Commercial |
$64.68
|
| Rate for Payer: Riverside University Health System MISP |
$30.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.68
|
| Rate for Payer: Vantage Medical Group Senior |
$64.68
|
|
|
HC INTRO ETT 15FR 70CM FLEXGDE
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901691012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.68
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.46
|
| Rate for Payer: Prime Health Services Commercial |
$64.68
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
906820183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.57 |
| 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 |
$1,286.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$832.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$832.15
|
| 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 |
$907.80
|
| 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 |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,286.05
|
| Rate for Payer: Dignity Health Media |
$1,286.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,286.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,134.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$529.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Riverside University Health System MISP |
$605.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| 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 |
$1,286.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,286.05
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| 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 |
$1,286.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$832.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$832.15
|
| 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 |
$907.80
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,286.05
|
| Rate for Payer: Dignity Health Media |
$1,286.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,286.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,134.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Riverside University Health System MISP |
$605.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$756.50
|
| Rate for Payer: United Healthcare All Other HMO |
$756.50
|
| Rate for Payer: United Healthcare HMO Rider |
$756.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$756.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,286.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,286.05
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
906820183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.57 |
| 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 |
$1,286.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$832.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$832.15
|
| 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 |
$907.80
|
| 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 |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,210.40
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,286.05
|
| Rate for Payer: Dignity Health Media |
$1,286.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,286.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,361.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,134.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$529.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.60
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Riverside University Health System MISP |
$605.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| 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 |
$1,286.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,286.05
|
|
|
HC INTRO PERCUTANEOUS 7FR
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC INTRO PERCUTANEOUS 7FR
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.17
|
| Rate for Payer: Blue Distinction Transplant |
$80.40
|
| Rate for Payer: Blue Shield of California Commercial |
$84.29
|
| Rate for Payer: Blue Shield of California EPN |
$65.53
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.90
|
| Rate for Payer: Dignity Health Media |
$113.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$100.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Riverside University Health System MISP |
$53.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67.00
|
| Rate for Payer: United Healthcare HMO Rider |
$67.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.90
|
| Rate for Payer: Vantage Medical Group Senior |
$113.90
|
|
