|
HC BAL ANGSCR ANGIOSCULPT CUTTING
|
Facility
|
IP
|
$3,120.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
906812366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,652.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,931.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: Networks By Design Commercial |
$2,028.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
|
|
HC BAL BARD ATLAS GOLD
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.80 |
| Max. Negotiated Rate |
$509.15 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$392.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$329.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.85
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cigna of CA HMO |
$383.36
|
| Rate for Payer: Cigna of CA PPO |
$443.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$509.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$509.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: EPIC Health Plan Senior |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$419.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$419.30
|
| Rate for Payer: Multiplan Commercial |
$479.20
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$359.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$359.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.50
|
| Rate for Payer: United Healthcare All Other HMO |
$299.50
|
| Rate for Payer: United Healthcare HMO Rider |
$299.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$509.15
|
| Rate for Payer: Vantage Medical Group Senior |
$509.15
|
|
|
HC BAL BARD ATLAS GOLD
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.80 |
| Max. Negotiated Rate |
$509.15 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: EPIC Health Plan Senior |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.76
|
| Rate for Payer: Multiplan Commercial |
$479.20
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
|
|
HC BAL BARD ATLAS PTA
|
Facility
|
OP
|
$1,610.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,368.50 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,368.50
|
| Rate for Payer: Adventist Health Commercial |
$322.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,056.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$885.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,207.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$988.70
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,191.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,368.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$644.00
|
| Rate for Payer: Galaxy Health WC |
$1,368.50
|
| Rate for Payer: Global Benefits Group Commercial |
$966.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,127.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,127.00
|
| Rate for Payer: Multiplan Commercial |
$1,288.00
|
| Rate for Payer: Networks By Design Commercial |
$1,046.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,368.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$966.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$966.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$805.00
|
| Rate for Payer: United Healthcare All Other HMO |
$805.00
|
| Rate for Payer: United Healthcare HMO Rider |
$805.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$805.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,368.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,368.50
|
|
|
HC BAL BARD ATLAS PTA
|
Facility
|
IP
|
$1,610.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,368.50 |
| Rate for Payer: Adventist Health Commercial |
$322.00
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$644.00
|
| Rate for Payer: Galaxy Health WC |
$1,368.50
|
| Rate for Payer: Global Benefits Group Commercial |
$966.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.40
|
| Rate for Payer: Multiplan Commercial |
$1,288.00
|
| Rate for Payer: Networks By Design Commercial |
$1,046.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,368.50
|
|
|
HC BAL BARD DORADO
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$468.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$638.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.90
|
| Rate for Payer: Blue Shield of California Commercial |
$628.04
|
| Rate for Payer: Blue Shield of California EPN |
$413.59
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cigna of CA HMO |
$595.70
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$723.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$723.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$723.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.70
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: Networks By Design Commercial |
$425.50
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.38
|
| Rate for Payer: United Healthcare All Other HMO |
$310.87
|
| Rate for Payer: United Healthcare HMO Rider |
$304.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$723.35
|
| Rate for Payer: Vantage Medical Group Senior |
$723.35
|
|
|
HC BAL BARD DORADO
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cigna of CA HMO |
$595.70
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.24
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: Networks By Design Commercial |
$425.50
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.38
|
| Rate for Payer: United Healthcare All Other HMO |
$310.87
|
| Rate for Payer: United Healthcare HMO Rider |
$304.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.70
|
|
|
HC BAL BARD TRUE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BAL BARD TRUE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC BAL BP STINGRAY
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BAL BP STINGRAY
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC BAL BRAUN COEFFICIENT
|
Facility
|
IP
|
$1,863.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cigna of CA HMO |
$1,304.10
|
| Rate for Payer: Cigna of CA PPO |
$1,304.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.12
|
| Rate for Payer: Multiplan Commercial |
$1,490.40
|
| Rate for Payer: Networks By Design Commercial |
$931.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.18
|
| Rate for Payer: United Healthcare All Other HMO |
$680.55
|
| Rate for Payer: United Healthcare HMO Rider |
$665.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.13
|
|
|
HC BAL BRAUN COEFFICIENT
|
Facility
|
OP
|
$1,863.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,583.55 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,024.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,397.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,079.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,374.89
|
| Rate for Payer: Blue Shield of California EPN |
$905.42
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cigna of CA HMO |
$1,304.10
|
| Rate for Payer: Cigna of CA PPO |
$1,304.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,583.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,583.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,304.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,304.10
|
| Rate for Payer: Multiplan Commercial |
$1,490.40
|
| Rate for Payer: Networks By Design Commercial |
$931.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,117.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.18
|
| Rate for Payer: United Healthcare All Other HMO |
$680.55
|
| Rate for Payer: United Healthcare HMO Rider |
$665.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,583.55
|
|
|
HC BAL BRAUN NUCLEUS
|
Facility
|
OP
|
$854.07
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$725.96 |
| Rate for Payer: Adventist Health Commercial |
$170.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$560.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$725.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$469.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$640.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.48
|
| Rate for Payer: Cash Price |
$384.33
|
| Rate for Payer: Cigna of CA HMO |
$546.60
|
| Rate for Payer: Cigna of CA PPO |
$632.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$725.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$725.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$725.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.63
|
| Rate for Payer: EPIC Health Plan Senior |
$341.63
|
| Rate for Payer: Galaxy Health WC |
$725.96
|
| Rate for Payer: Global Benefits Group Commercial |
$512.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$597.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$597.85
|
| Rate for Payer: Multiplan Commercial |
$683.26
|
| Rate for Payer: Networks By Design Commercial |
$555.15
|
| Rate for Payer: Prime Health Services Commercial |
$725.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.04
|
| Rate for Payer: United Healthcare All Other HMO |
$427.04
|
| Rate for Payer: United Healthcare HMO Rider |
$427.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$725.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$725.96
|
| Rate for Payer: Vantage Medical Group Senior |
$725.96
|
|
|
HC BAL BRAUN NUCLEUS
|
Facility
|
IP
|
$854.07
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$725.96 |
| Rate for Payer: Adventist Health Commercial |
$170.81
|
| Rate for Payer: Cash Price |
$384.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.63
|
| Rate for Payer: EPIC Health Plan Senior |
$341.63
|
| Rate for Payer: Galaxy Health WC |
$725.96
|
| Rate for Payer: Global Benefits Group Commercial |
$512.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.98
|
| Rate for Payer: Multiplan Commercial |
$683.26
|
| Rate for Payer: Networks By Design Commercial |
$555.15
|
| Rate for Payer: Prime Health Services Commercial |
$725.96
|
|
|
HC BAL BRAUN TYSHAK MINI
|
Facility
|
IP
|
$2,103.07
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.61 |
| Max. Negotiated Rate |
$1,787.61 |
| Rate for Payer: Adventist Health Commercial |
$420.61
|
| Rate for Payer: Cash Price |
$946.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$841.23
|
| Rate for Payer: EPIC Health Plan Senior |
$841.23
|
| Rate for Payer: Galaxy Health WC |
$1,787.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,402.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,301.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.74
|
| Rate for Payer: Multiplan Commercial |
$1,682.46
|
| Rate for Payer: Networks By Design Commercial |
$1,367.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,787.61
|
|
|
HC BAL BRAUN TYSHAK MINI
|
Facility
|
OP
|
$2,103.07
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.61 |
| Max. Negotiated Rate |
$1,787.61 |
| Rate for Payer: Adventist Health Commercial |
$420.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,379.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,787.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,156.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,577.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,291.50
|
| Rate for Payer: Cash Price |
$946.38
|
| Rate for Payer: Cigna of CA HMO |
$1,345.96
|
| Rate for Payer: Cigna of CA PPO |
$1,556.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,787.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,787.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,787.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$841.23
|
| Rate for Payer: EPIC Health Plan Senior |
$841.23
|
| Rate for Payer: Galaxy Health WC |
$1,787.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,402.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,301.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,472.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,472.15
|
| Rate for Payer: Multiplan Commercial |
$1,682.46
|
| Rate for Payer: Networks By Design Commercial |
$1,367.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,787.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,261.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,261.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,051.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,051.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,051.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,051.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,787.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,787.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,787.61
|
|
|
HC BAL BRAUN Z-MED II 10CM SMALL
|
Facility
|
IP
|
$1,507.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cigna of CA HMO |
$1,054.90
|
| Rate for Payer: Cigna of CA PPO |
$1,054.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$602.80
|
| Rate for Payer: Galaxy Health WC |
$1,280.95
|
| Rate for Payer: Global Benefits Group Commercial |
$904.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,005.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$574.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$932.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.68
|
| Rate for Payer: Multiplan Commercial |
$1,205.60
|
| Rate for Payer: Networks By Design Commercial |
$753.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,280.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$565.58
|
| Rate for Payer: United Healthcare All Other HMO |
$550.51
|
| Rate for Payer: United Healthcare HMO Rider |
$538.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$493.54
|
|
|
HC BAL BRAUN Z-MED II 10CM SMALL
|
Facility
|
OP
|
$1,507.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.40 |
| Max. Negotiated Rate |
$1,280.95 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$828.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,130.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$872.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,112.17
|
| Rate for Payer: Blue Shield of California EPN |
$732.40
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cigna of CA HMO |
$1,054.90
|
| Rate for Payer: Cigna of CA PPO |
$1,054.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,280.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,280.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$602.80
|
| Rate for Payer: Galaxy Health WC |
$1,280.95
|
| Rate for Payer: Global Benefits Group Commercial |
$904.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,005.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$574.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$932.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,054.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,054.90
|
| Rate for Payer: Multiplan Commercial |
$1,205.60
|
| Rate for Payer: Networks By Design Commercial |
$753.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,280.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$904.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$904.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$565.58
|
| Rate for Payer: United Healthcare All Other HMO |
$550.51
|
| Rate for Payer: United Healthcare HMO Rider |
$538.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$493.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,280.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,280.95
|
|
|
HC BAL BRAUN Z-MED II 12CM LARGER
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
|
HC BAL BRAUN Z-MED II 12CM LARGER
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,332.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,697.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC BAL BRAUN Z-MED II CUSTOM
|
Facility
|
OP
|
$2,671.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.20 |
| Max. Negotiated Rate |
$2,270.35 |
| Rate for Payer: Adventist Health Commercial |
$534.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,469.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,547.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,971.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,298.11
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Cigna of CA HMO |
$1,869.70
|
| Rate for Payer: Cigna of CA PPO |
$1,869.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,270.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,270.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,068.40
|
| Rate for Payer: Galaxy Health WC |
$2,270.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,602.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,781.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,017.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,653.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$641.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,869.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,869.70
|
| Rate for Payer: Multiplan Commercial |
$2,136.80
|
| Rate for Payer: Networks By Design Commercial |
$1,335.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,270.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,602.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,602.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,002.43
|
| Rate for Payer: United Healthcare All Other HMO |
$975.72
|
| Rate for Payer: United Healthcare HMO Rider |
$954.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$874.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,270.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,270.35
|
|
|
HC BAL BRAUN Z-MED II CUSTOM
|
Facility
|
IP
|
$2,671.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$534.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Cigna of CA HMO |
$1,869.70
|
| Rate for Payer: Cigna of CA PPO |
$1,869.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,068.40
|
| Rate for Payer: Galaxy Health WC |
$2,270.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,602.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,781.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,017.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,653.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$641.04
|
| Rate for Payer: Multiplan Commercial |
$2,136.80
|
| Rate for Payer: Networks By Design Commercial |
$1,335.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,270.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,002.43
|
| Rate for Payer: United Healthcare All Other HMO |
$975.72
|
| Rate for Payer: United Healthcare HMO Rider |
$954.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$874.75
|
|
|
HC BAL B/S APEX
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$527.85 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$407.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.36
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: Cigna of CA HMO |
$397.44
|
| Rate for Payer: Cigna of CA PPO |
$459.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$527.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$527.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.40
|
| Rate for Payer: EPIC Health Plan Senior |
$248.40
|
| Rate for Payer: Galaxy Health WC |
$527.85
|
| Rate for Payer: Global Benefits Group Commercial |
$372.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$384.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$434.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$434.70
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Networks By Design Commercial |
$403.65
|
| Rate for Payer: Prime Health Services Commercial |
$527.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.50
|
| Rate for Payer: United Healthcare All Other HMO |
$310.50
|
| Rate for Payer: United Healthcare HMO Rider |
$310.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.85
|
| Rate for Payer: Vantage Medical Group Senior |
$527.85
|
|
|
HC BAL B/S APEX
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$527.85 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.40
|
| Rate for Payer: EPIC Health Plan Senior |
$248.40
|
| Rate for Payer: Galaxy Health WC |
$527.85
|
| Rate for Payer: Global Benefits Group Commercial |
$372.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$384.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.04
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Networks By Design Commercial |
$403.65
|
| Rate for Payer: Prime Health Services Commercial |
$527.85
|
|
