|
HC CATH AIRWAY EXCHANGE 19FR
|
Facility
|
IP
|
$393.18
|
|
| Hospital Charge Code |
901604178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.64 |
| Max. Negotiated Rate |
$334.20 |
| Rate for Payer: Adventist Health Commercial |
$78.64
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.27
|
| Rate for Payer: EPIC Health Plan Senior |
$157.27
|
| Rate for Payer: Galaxy Health WC |
$334.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.36
|
| Rate for Payer: Multiplan Commercial |
$314.54
|
| Rate for Payer: Networks By Design Commercial |
$255.57
|
| Rate for Payer: Prime Health Services Commercial |
$334.20
|
|
|
HC CATH AIRWAY EXCHANGE 8FR
|
Facility
|
IP
|
$393.18
|
|
| Hospital Charge Code |
901603693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.64 |
| Max. Negotiated Rate |
$334.20 |
| Rate for Payer: Adventist Health Commercial |
$78.64
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.27
|
| Rate for Payer: EPIC Health Plan Senior |
$157.27
|
| Rate for Payer: Galaxy Health WC |
$334.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.36
|
| Rate for Payer: Multiplan Commercial |
$314.54
|
| Rate for Payer: Networks By Design Commercial |
$255.57
|
| Rate for Payer: Prime Health Services Commercial |
$334.20
|
|
|
HC CATH AIRWAY EXCHANGE 8FR
|
Facility
|
OP
|
$393.18
|
|
| Hospital Charge Code |
901603693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.64 |
| Max. Negotiated Rate |
$334.20 |
| Rate for Payer: Adventist Health Commercial |
$78.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.45
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: Cigna of CA HMO |
$251.64
|
| Rate for Payer: Cigna of CA PPO |
$290.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.27
|
| Rate for Payer: EPIC Health Plan Senior |
$157.27
|
| Rate for Payer: Galaxy Health WC |
$334.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$275.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$275.23
|
| Rate for Payer: Multiplan Commercial |
$314.54
|
| Rate for Payer: Networks By Design Commercial |
$255.57
|
| Rate for Payer: Prime Health Services Commercial |
$334.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.59
|
| Rate for Payer: United Healthcare All Other HMO |
$196.59
|
| Rate for Payer: United Healthcare HMO Rider |
$196.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.20
|
| Rate for Payer: Vantage Medical Group Senior |
$334.20
|
|
|
HC CATH ANGIODYN SOFT-VU
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.03
|
| Rate for Payer: Blue Shield of California Commercial |
$84.13
|
| Rate for Payer: Blue Shield of California EPN |
$55.40
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna of CA HMO |
$79.80
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.80
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$57.00
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.78
|
| Rate for Payer: United Healthcare All Other HMO |
$41.64
|
| Rate for Payer: United Healthcare HMO Rider |
$40.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Vantage Medical Group Senior |
$96.90
|
|
|
HC CATH ANGIODYN SOFT-VU
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna of CA HMO |
$79.80
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$57.00
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.78
|
| Rate for Payer: United Healthcare All Other HMO |
$41.64
|
| Rate for Payer: United Healthcare HMO Rider |
$40.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.34
|
|
|
HC CATH ARGON T/D BAL
|
Facility
|
IP
|
$537.37
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
906811756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.47 |
| Max. Negotiated Rate |
$456.76 |
| Rate for Payer: Adventist Health Commercial |
$107.47
|
| Rate for Payer: Cash Price |
$295.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.95
|
| Rate for Payer: EPIC Health Plan Senior |
$214.95
|
| Rate for Payer: Galaxy Health WC |
$456.76
|
| Rate for Payer: Global Benefits Group Commercial |
$322.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$332.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.97
|
| Rate for Payer: Multiplan Commercial |
$429.90
|
| Rate for Payer: Networks By Design Commercial |
$349.29
|
| Rate for Payer: Prime Health Services Commercial |
$456.76
|
|
|
HC CATH ARGON T/D BAL
|
Facility
|
OP
|
$537.37
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
906811756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.47 |
| Max. Negotiated Rate |
$456.76 |
| Rate for Payer: Adventist Health Commercial |
$107.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$295.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.00
|
| Rate for Payer: Cash Price |
$295.55
|
| Rate for Payer: Cigna of CA HMO |
$343.92
|
| Rate for Payer: Cigna of CA PPO |
$397.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$456.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$456.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.95
|
| Rate for Payer: EPIC Health Plan Senior |
$214.95
|
| Rate for Payer: Galaxy Health WC |
$456.76
|
| Rate for Payer: Global Benefits Group Commercial |
$322.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$332.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$376.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$376.16
|
| Rate for Payer: Multiplan Commercial |
$429.90
|
| Rate for Payer: Networks By Design Commercial |
$349.29
|
| Rate for Payer: Prime Health Services Commercial |
$456.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.69
|
| Rate for Payer: United Healthcare All Other HMO |
$268.69
|
| Rate for Payer: United Healthcare HMO Rider |
$268.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$456.76
|
| Rate for Payer: Vantage Medical Group Senior |
$456.76
|
|
|
HC CATH ARROW ANGIO BAL
|
Facility
|
OP
|
$247.87
|
|
| Hospital Charge Code |
906812007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.57 |
| Max. Negotiated Rate |
$210.69 |
| Rate for Payer: Adventist Health Commercial |
$49.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.22
|
| Rate for Payer: Cash Price |
$136.33
|
| Rate for Payer: Cigna of CA HMO |
$158.64
|
| Rate for Payer: Cigna of CA PPO |
$183.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.15
|
| Rate for Payer: EPIC Health Plan Senior |
$99.15
|
| Rate for Payer: Galaxy Health WC |
$210.69
|
| Rate for Payer: Global Benefits Group Commercial |
$148.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.51
|
| Rate for Payer: Multiplan Commercial |
$198.30
|
| Rate for Payer: Networks By Design Commercial |
$161.12
|
| Rate for Payer: Prime Health Services Commercial |
$210.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.94
|
| Rate for Payer: United Healthcare All Other HMO |
$123.94
|
| Rate for Payer: United Healthcare HMO Rider |
$123.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.69
|
| Rate for Payer: Vantage Medical Group Senior |
$210.69
|
|
|
HC CATH ARROW ANGIO BAL
|
Facility
|
IP
|
$247.87
|
|
| Hospital Charge Code |
906812007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.57 |
| Max. Negotiated Rate |
$210.69 |
| Rate for Payer: Adventist Health Commercial |
$49.57
|
| Rate for Payer: Cash Price |
$136.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.15
|
| Rate for Payer: EPIC Health Plan Senior |
$99.15
|
| Rate for Payer: Galaxy Health WC |
$210.69
|
| Rate for Payer: Global Benefits Group Commercial |
$148.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.49
|
| Rate for Payer: Multiplan Commercial |
$198.30
|
| Rate for Payer: Networks By Design Commercial |
$161.12
|
| Rate for Payer: Prime Health Services Commercial |
$210.69
|
|
|
HC CATH ARROW T/D BAL
|
Facility
|
IP
|
$334.04
|
|
| Hospital Charge Code |
906812009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.81 |
| Max. Negotiated Rate |
$283.93 |
| Rate for Payer: Adventist Health Commercial |
$66.81
|
| Rate for Payer: Cash Price |
$183.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.62
|
| Rate for Payer: EPIC Health Plan Senior |
$133.62
|
| Rate for Payer: Galaxy Health WC |
$283.93
|
| Rate for Payer: Global Benefits Group Commercial |
$200.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: Multiplan Commercial |
$267.23
|
| Rate for Payer: Networks By Design Commercial |
$217.13
|
| Rate for Payer: Prime Health Services Commercial |
$283.93
|
|
|
HC CATH ARROW T/D BAL
|
Facility
|
OP
|
$334.04
|
|
| Hospital Charge Code |
906812009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.81 |
| Max. Negotiated Rate |
$283.93 |
| Rate for Payer: Adventist Health Commercial |
$66.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$219.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$183.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.13
|
| Rate for Payer: Cash Price |
$183.72
|
| Rate for Payer: Cigna of CA HMO |
$213.79
|
| Rate for Payer: Cigna of CA PPO |
$247.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$283.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.62
|
| Rate for Payer: EPIC Health Plan Senior |
$133.62
|
| Rate for Payer: Galaxy Health WC |
$283.93
|
| Rate for Payer: Global Benefits Group Commercial |
$200.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.83
|
| Rate for Payer: Multiplan Commercial |
$267.23
|
| Rate for Payer: Networks By Design Commercial |
$217.13
|
| Rate for Payer: Prime Health Services Commercial |
$283.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.02
|
| Rate for Payer: United Healthcare All Other HMO |
$167.02
|
| Rate for Payer: United Healthcare HMO Rider |
$167.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.93
|
| Rate for Payer: Vantage Medical Group Senior |
$283.93
|
|
|
HC CATH ARROW T/D BAL 6FR 110CM
|
Facility
|
IP
|
$563.00
|
|
| Hospital Charge Code |
906812367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$478.55 |
| Rate for Payer: Adventist Health Commercial |
$112.60
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.12
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
|
|
HC CATH ARROW T/D BAL 6FR 110CM
|
Facility
|
OP
|
$563.00
|
|
| Hospital Charge Code |
906812367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$478.55 |
| Rate for Payer: Adventist Health Commercial |
$112.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$369.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.74
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cigna of CA HMO |
$360.32
|
| Rate for Payer: Cigna of CA PPO |
$416.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.10
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.50
|
| Rate for Payer: United Healthcare All Other HMO |
$281.50
|
| Rate for Payer: United Healthcare HMO Rider |
$281.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.55
|
| Rate for Payer: Vantage Medical Group Senior |
$478.55
|
|
|
HC CATH, ARROW-TRETOTOLA THROMBOL
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$792.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.72
|
| Rate for Payer: Blue Shield of California EPN |
$699.84
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,224.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,008.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,224.00
|
|
|
HC CATH, ARROW-TRETOTOLA THROMBOL
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
|
|
HC CATH ARROW TWO-LUMEN CVP 9FR
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
906812635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$481.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.83
|
| Rate for Payer: Blue Shield of California Commercial |
$417.71
|
| Rate for Payer: Blue Shield of California EPN |
$275.08
|
| Rate for Payer: Cash Price |
$311.30
|
| Rate for Payer: Cigna of CA HMO |
$396.20
|
| Rate for Payer: Cigna of CA PPO |
$396.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Senior |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$396.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$396.20
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Networks By Design Commercial |
$283.00
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.42
|
| Rate for Payer: United Healthcare All Other HMO |
$206.76
|
| Rate for Payer: United Healthcare HMO Rider |
$202.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$481.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.10
|
| Rate for Payer: Vantage Medical Group Senior |
$481.10
|
|
|
HC CATH ARROW TWO-LUMEN CVP 9FR
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
906812635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$311.30
|
| Rate for Payer: Cash Price |
$311.30
|
| Rate for Payer: Cigna of CA HMO |
$396.20
|
| Rate for Payer: Cigna of CA PPO |
$396.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Senior |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.84
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Networks By Design Commercial |
$283.00
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.42
|
| Rate for Payer: United Healthcare All Other HMO |
$206.76
|
| Rate for Payer: United Healthcare HMO Rider |
$202.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.37
|
|
|
HC CATH ARTERIAL 20GA X1-3/4" KIT
|
Facility
|
IP
|
$214.90
|
|
| Hospital Charge Code |
901698169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$182.66 |
| Rate for Payer: Adventist Health Commercial |
$42.98
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.96
|
| Rate for Payer: EPIC Health Plan Senior |
$85.96
|
| Rate for Payer: Galaxy Health WC |
$182.66
|
| Rate for Payer: Global Benefits Group Commercial |
$128.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.58
|
| Rate for Payer: Multiplan Commercial |
$171.92
|
| Rate for Payer: Networks By Design Commercial |
$139.69
|
| Rate for Payer: Prime Health Services Commercial |
$182.66
|
|
|
HC CATH ARTERIAL 20GA X1-3/4" KIT
|
Facility
|
OP
|
$214.90
|
|
| Hospital Charge Code |
901698169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$182.66 |
| Rate for Payer: Adventist Health Commercial |
$42.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$182.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.97
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna of CA HMO |
$137.54
|
| Rate for Payer: Cigna of CA PPO |
$159.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$182.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$182.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.96
|
| Rate for Payer: EPIC Health Plan Senior |
$85.96
|
| Rate for Payer: Galaxy Health WC |
$182.66
|
| Rate for Payer: Global Benefits Group Commercial |
$128.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$150.43
|
| Rate for Payer: Multiplan Commercial |
$171.92
|
| Rate for Payer: Networks By Design Commercial |
$139.69
|
| Rate for Payer: Prime Health Services Commercial |
$182.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.45
|
| Rate for Payer: United Healthcare All Other HMO |
$107.45
|
| Rate for Payer: United Healthcare HMO Rider |
$107.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$182.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.66
|
| Rate for Payer: Vantage Medical Group Senior |
$182.66
|
|
|
HC CATH ARTERIAL KIT 20GA
|
Facility
|
OP
|
$318.29
|
|
| Hospital Charge Code |
901607626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$270.55 |
| Rate for Payer: Adventist Health Commercial |
$63.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.46
|
| Rate for Payer: Cash Price |
$175.06
|
| Rate for Payer: Cigna of CA HMO |
$203.71
|
| Rate for Payer: Cigna of CA PPO |
$235.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.32
|
| Rate for Payer: EPIC Health Plan Senior |
$127.32
|
| Rate for Payer: Galaxy Health WC |
$270.55
|
| Rate for Payer: Global Benefits Group Commercial |
$190.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$222.80
|
| Rate for Payer: Multiplan Commercial |
$254.63
|
| Rate for Payer: Networks By Design Commercial |
$206.89
|
| Rate for Payer: Prime Health Services Commercial |
$270.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.15
|
| Rate for Payer: United Healthcare All Other HMO |
$159.15
|
| Rate for Payer: United Healthcare HMO Rider |
$159.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.55
|
| Rate for Payer: Vantage Medical Group Senior |
$270.55
|
|
|
HC CATH ARTERIAL KIT 20GA
|
Facility
|
OP
|
$203.00
|
|
| Hospital Charge Code |
901698701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$172.55 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.66
|
| Rate for Payer: Cash Price |
$111.65
|
| Rate for Payer: Cigna of CA HMO |
$129.92
|
| Rate for Payer: Cigna of CA PPO |
$150.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.20
|
| Rate for Payer: EPIC Health Plan Senior |
$81.20
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.10
|
| Rate for Payer: Multiplan Commercial |
$162.40
|
| Rate for Payer: Networks By Design Commercial |
$131.95
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.50
|
| Rate for Payer: United Healthcare All Other HMO |
$101.50
|
| Rate for Payer: United Healthcare HMO Rider |
$101.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.55
|
| Rate for Payer: Vantage Medical Group Senior |
$172.55
|
|
|
HC CATH ARTERIAL KIT 20GA
|
Facility
|
IP
|
$203.00
|
|
| Hospital Charge Code |
901698701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$172.55 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Cash Price |
$111.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.20
|
| Rate for Payer: EPIC Health Plan Senior |
$81.20
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.72
|
| Rate for Payer: Multiplan Commercial |
$162.40
|
| Rate for Payer: Networks By Design Commercial |
$131.95
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
|
|
HC CATH ARTERIAL KIT 20GA
|
Facility
|
IP
|
$318.29
|
|
| Hospital Charge Code |
901607626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$270.55 |
| Rate for Payer: Adventist Health Commercial |
$63.66
|
| Rate for Payer: Cash Price |
$175.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.32
|
| Rate for Payer: EPIC Health Plan Senior |
$127.32
|
| Rate for Payer: Galaxy Health WC |
$270.55
|
| Rate for Payer: Global Benefits Group Commercial |
$190.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.39
|
| Rate for Payer: Multiplan Commercial |
$254.63
|
| Rate for Payer: Networks By Design Commercial |
$206.89
|
| Rate for Payer: Prime Health Services Commercial |
$270.55
|
|
|
HC CATH ARTERIAL SET 18GA X 12CM
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.34
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC CATH ARTERIAL SET 18GA X 12CM
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
