|
HC CATH BRAUN MULTI TRACK 5FR
|
Facility
|
OP
|
$250.67
|
|
| Hospital Charge Code |
906812268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$213.07 |
| Rate for Payer: Adventist Health Commercial |
$50.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.94
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$160.43
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$213.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.27
|
| Rate for Payer: EPIC Health Plan Senior |
$100.27
|
| Rate for Payer: Galaxy Health WC |
$213.07
|
| Rate for Payer: Global Benefits Group Commercial |
$150.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.47
|
| Rate for Payer: Multiplan Commercial |
$200.54
|
| Rate for Payer: Networks By Design Commercial |
$162.94
|
| Rate for Payer: Prime Health Services Commercial |
$213.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.33
|
| Rate for Payer: United Healthcare All Other HMO |
$125.33
|
| Rate for Payer: United Healthcare HMO Rider |
$125.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.07
|
| Rate for Payer: Vantage Medical Group Senior |
$213.07
|
|
|
HC CATH BRAUN MULTI TRACK 6FR
|
Facility
|
OP
|
$303.80
|
|
| Hospital Charge Code |
906812437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$258.23 |
| Rate for Payer: Adventist Health Commercial |
$60.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.56
|
| Rate for Payer: Cash Price |
$136.71
|
| Rate for Payer: Cigna of CA HMO |
$194.43
|
| Rate for Payer: Cigna of CA PPO |
$224.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.52
|
| Rate for Payer: EPIC Health Plan Senior |
$121.52
|
| Rate for Payer: Galaxy Health WC |
$258.23
|
| Rate for Payer: Global Benefits Group Commercial |
$182.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.66
|
| Rate for Payer: Multiplan Commercial |
$243.04
|
| Rate for Payer: Networks By Design Commercial |
$197.47
|
| Rate for Payer: Prime Health Services Commercial |
$258.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.90
|
| Rate for Payer: United Healthcare All Other HMO |
$151.90
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$258.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.23
|
| Rate for Payer: Vantage Medical Group Senior |
$258.23
|
|
|
HC CATH BRAUN MULTI TRACK 6FR
|
Facility
|
IP
|
$303.80
|
|
| Hospital Charge Code |
906812437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$258.23 |
| Rate for Payer: Adventist Health Commercial |
$60.76
|
| Rate for Payer: Cash Price |
$136.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.52
|
| Rate for Payer: EPIC Health Plan Senior |
$121.52
|
| Rate for Payer: Galaxy Health WC |
$258.23
|
| Rate for Payer: Global Benefits Group Commercial |
$182.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.91
|
| Rate for Payer: Multiplan Commercial |
$243.04
|
| Rate for Payer: Networks By Design Commercial |
$197.47
|
| Rate for Payer: Prime Health Services Commercial |
$258.23
|
|
|
HC CATH BROVIAC 4.2FR 90CM PEDS
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901603657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,468.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,870.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,232.01
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC CATH BROVIAC 4.2FR 90CM PEDS
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901603657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
|
|
HC CATH BROVIAC 4.2FR WH
|
Facility
|
IP
|
$2,382.90
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.58 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$476.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,072.31
|
| Rate for Payer: Cash Price |
$1,072.31
|
| Rate for Payer: Cigna of CA HMO |
$1,668.03
|
| Rate for Payer: Cigna of CA PPO |
$1,668.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.16
|
| Rate for Payer: EPIC Health Plan Senior |
$953.16
|
| Rate for Payer: Galaxy Health WC |
$2,025.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,475.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.90
|
| Rate for Payer: Multiplan Commercial |
$1,906.32
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$894.30
|
| Rate for Payer: United Healthcare All Other HMO |
$870.47
|
| Rate for Payer: United Healthcare HMO Rider |
$851.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$780.40
|
|
|
HC CATH BROVIAC 4.2FR WH
|
Facility
|
OP
|
$2,382.90
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.58 |
| Max. Negotiated Rate |
$2,025.46 |
| Rate for Payer: Adventist Health Commercial |
$476.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,025.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,787.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,380.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,758.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,158.09
|
| Rate for Payer: Cash Price |
$1,072.31
|
| Rate for Payer: Cigna of CA HMO |
$1,668.03
|
| Rate for Payer: Cigna of CA PPO |
$1,668.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,025.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,025.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,025.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.16
|
| Rate for Payer: EPIC Health Plan Senior |
$953.16
|
| Rate for Payer: Galaxy Health WC |
$2,025.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,475.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,668.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,668.03
|
| Rate for Payer: Multiplan Commercial |
$1,906.32
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,429.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$894.30
|
| Rate for Payer: United Healthcare All Other HMO |
$870.47
|
| Rate for Payer: United Healthcare HMO Rider |
$851.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$780.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,025.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,025.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.46
|
|
|
HC CATH BS ACUITY DELIVERY SYS
|
Facility
|
IP
|
$3,744.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,317.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$898.56
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Networks By Design Commercial |
$2,433.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
|
|
HC CATH BS ACUITY DELIVERY SYS
|
Facility
|
OP
|
$3,744.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,455.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,059.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,808.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.19
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cigna of CA HMO |
$2,396.16
|
| Rate for Payer: Cigna of CA PPO |
$2,770.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,182.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,317.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$898.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,620.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,620.80
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Networks By Design Commercial |
$2,433.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,872.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,872.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,182.40
|
|
|
HC CATH BS CATH RUNWAY 125CM
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC CATH BS CATH RUNWAY 125CM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC CATH BS MACH GUIDE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC CATH BS MACH GUIDE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC CATH B/S RENEGADE MICRO
|
Facility
|
OP
|
$2,106.34
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.27 |
| Max. Negotiated Rate |
$1,790.39 |
| Rate for Payer: Adventist Health Commercial |
$421.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,381.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,790.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,158.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,579.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,293.50
|
| Rate for Payer: Cash Price |
$947.85
|
| Rate for Payer: Cigna of CA HMO |
$1,348.06
|
| Rate for Payer: Cigna of CA PPO |
$1,558.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,790.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,790.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,790.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$842.54
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$1,790.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,263.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,404.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$802.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,303.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,474.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,474.44
|
| Rate for Payer: Multiplan Commercial |
$1,685.07
|
| Rate for Payer: Networks By Design Commercial |
$1,369.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,790.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,263.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,263.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,053.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1,053.17
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,790.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,790.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,790.39
|
|
|
HC CATH B/S RENEGADE MICRO
|
Facility
|
IP
|
$2,106.34
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.27 |
| Max. Negotiated Rate |
$1,790.39 |
| Rate for Payer: Adventist Health Commercial |
$421.27
|
| Rate for Payer: Cash Price |
$947.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$842.54
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$1,790.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,263.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,404.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$802.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,303.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.52
|
| Rate for Payer: Multiplan Commercial |
$1,685.07
|
| Rate for Payer: Networks By Design Commercial |
$1,369.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,790.39
|
|
|
HC CATH CATALYST THROM
|
Facility
|
OP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$4,781.25 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,218.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,258.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,151.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,733.75
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,781.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,781.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,143.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,481.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,937.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,937.50
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,375.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,781.25
|
|
|
HC CATH CATALYST THROM
|
Facility
|
IP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,143.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,481.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
|
|
HC CATH CEREBROFLO EVD KIT 10FR
|
Facility
|
OP
|
$3,397.68
|
|
| Hospital Charge Code |
901698291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$679.54 |
| Max. Negotiated Rate |
$2,888.03 |
| Rate for Payer: Adventist Health Commercial |
$679.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,228.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,888.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,868.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,548.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,086.52
|
| Rate for Payer: Cash Price |
$1,528.96
|
| Rate for Payer: Cigna of CA HMO |
$2,174.52
|
| Rate for Payer: Cigna of CA PPO |
$2,514.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,888.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,888.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,888.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,359.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1,359.07
|
| Rate for Payer: Galaxy Health WC |
$2,888.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2,038.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,266.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,294.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,103.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,378.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,378.38
|
| Rate for Payer: Multiplan Commercial |
$2,718.14
|
| Rate for Payer: Networks By Design Commercial |
$2,208.49
|
| Rate for Payer: Prime Health Services Commercial |
$2,888.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,038.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,038.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,698.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,698.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,698.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,698.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,888.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,888.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2,888.03
|
|
|
HC CATH CEREBROFLO EVD KIT 10FR
|
Facility
|
IP
|
$3,397.68
|
|
| Hospital Charge Code |
901698291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$679.54 |
| Max. Negotiated Rate |
$2,888.03 |
| Rate for Payer: Adventist Health Commercial |
$679.54
|
| Rate for Payer: Cash Price |
$1,528.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,359.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1,359.07
|
| Rate for Payer: Galaxy Health WC |
$2,888.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2,038.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,266.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,294.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,103.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.44
|
| Rate for Payer: Multiplan Commercial |
$2,718.14
|
| Rate for Payer: Networks By Design Commercial |
$2,208.49
|
| Rate for Payer: Prime Health Services Commercial |
$2,888.03
|
|
|
HC CATH CHEST 9.6FR INFANT
|
Facility
|
OP
|
$165.48
|
|
| Hospital Charge Code |
901602295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$140.66 |
| Rate for Payer: Adventist Health Commercial |
$33.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$140.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.62
|
| Rate for Payer: Cash Price |
$74.47
|
| Rate for Payer: Cigna of CA HMO |
$105.91
|
| Rate for Payer: Cigna of CA PPO |
$122.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.19
|
| Rate for Payer: EPIC Health Plan Senior |
$66.19
|
| Rate for Payer: Galaxy Health WC |
$140.66
|
| Rate for Payer: Global Benefits Group Commercial |
$99.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$115.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$115.84
|
| Rate for Payer: Multiplan Commercial |
$132.38
|
| Rate for Payer: Networks By Design Commercial |
$107.56
|
| Rate for Payer: Prime Health Services Commercial |
$140.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.74
|
| Rate for Payer: United Healthcare All Other HMO |
$82.74
|
| Rate for Payer: United Healthcare HMO Rider |
$82.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$140.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.66
|
| Rate for Payer: Vantage Medical Group Senior |
$140.66
|
|
|
HC CATH CHEST 9.6FR INFANT
|
Facility
|
IP
|
$165.48
|
|
| Hospital Charge Code |
901602295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$140.66 |
| Rate for Payer: Adventist Health Commercial |
$33.10
|
| Rate for Payer: Cash Price |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.19
|
| Rate for Payer: EPIC Health Plan Senior |
$66.19
|
| Rate for Payer: Galaxy Health WC |
$140.66
|
| Rate for Payer: Global Benefits Group Commercial |
$99.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.72
|
| Rate for Payer: Multiplan Commercial |
$132.38
|
| Rate for Payer: Networks By Design Commercial |
$107.56
|
| Rate for Payer: Prime Health Services Commercial |
$140.66
|
|
|
HC CATH CLEANER THROM
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$2,922.30 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,890.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,578.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,991.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2,537.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,670.87
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cigna of CA HMO |
$2,406.60
|
| Rate for Payer: Cigna of CA PPO |
$2,406.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,922.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,922.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,375.20
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,293.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,128.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,406.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,406.60
|
| Rate for Payer: Multiplan Commercial |
$2,750.40
|
| Rate for Payer: Networks By Design Commercial |
$1,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,062.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,290.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,228.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,125.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,922.30
|
|
|
HC CATH CLEANER THROM
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cigna of CA HMO |
$2,406.60
|
| Rate for Payer: Cigna of CA PPO |
$2,406.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,375.20
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,293.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,128.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.12
|
| Rate for Payer: Multiplan Commercial |
$2,750.40
|
| Rate for Payer: Networks By Design Commercial |
$1,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,290.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,228.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,125.94
|
|
|
HC CATH CLOSED SUCTION 10FR
|
Facility
|
OP
|
$104.96
|
|
| Hospital Charge Code |
901605543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$89.22 |
| Rate for Payer: Adventist Health Commercial |
$20.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.46
|
| Rate for Payer: Cash Price |
$47.23
|
| Rate for Payer: Cigna of CA HMO |
$67.17
|
| Rate for Payer: Cigna of CA PPO |
$77.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.98
|
| Rate for Payer: EPIC Health Plan Senior |
$41.98
|
| Rate for Payer: Galaxy Health WC |
$89.22
|
| Rate for Payer: Global Benefits Group Commercial |
$62.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.47
|
| Rate for Payer: Multiplan Commercial |
$83.97
|
| Rate for Payer: Networks By Design Commercial |
$68.22
|
| Rate for Payer: Prime Health Services Commercial |
$89.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.48
|
| Rate for Payer: United Healthcare All Other HMO |
$52.48
|
| Rate for Payer: United Healthcare HMO Rider |
$52.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.22
|
| Rate for Payer: Vantage Medical Group Senior |
$89.22
|
|
|
HC CATH CLOSED SUCTION 10FR
|
Facility
|
IP
|
$104.96
|
|
| Hospital Charge Code |
901605543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$89.22 |
| Rate for Payer: Adventist Health Commercial |
$20.99
|
| Rate for Payer: Cash Price |
$47.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.98
|
| Rate for Payer: EPIC Health Plan Senior |
$41.98
|
| Rate for Payer: Galaxy Health WC |
$89.22
|
| Rate for Payer: Global Benefits Group Commercial |
$62.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.19
|
| Rate for Payer: Multiplan Commercial |
$83.97
|
| Rate for Payer: Networks By Design Commercial |
$68.22
|
| Rate for Payer: Prime Health Services Commercial |
$89.22
|
|
