|
HC CATH COUDE 12FR
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901601804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Adventist Health Commercial |
$7.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.36
|
| Rate for Payer: Cash Price |
$20.03
|
| Rate for Payer: Cigna of CA HMO |
$23.30
|
| Rate for Payer: Cigna of CA PPO |
$26.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.56
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$30.95
|
| Rate for Payer: Global Benefits Group Commercial |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.49
|
| Rate for Payer: Multiplan Commercial |
$29.13
|
| Rate for Payer: Networks By Design Commercial |
$23.67
|
| Rate for Payer: Prime Health Services Commercial |
$30.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.20
|
| Rate for Payer: United Healthcare All Other HMO |
$18.20
|
| Rate for Payer: United Healthcare HMO Rider |
$18.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.95
|
|
|
HC CATH COUDE 14FR
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901601805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Adventist Health Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$20.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.56
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$30.95
|
| Rate for Payer: Global Benefits Group Commercial |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Multiplan Commercial |
$29.13
|
| Rate for Payer: Networks By Design Commercial |
$23.67
|
| Rate for Payer: Prime Health Services Commercial |
$30.95
|
|
|
HC CATH COUDE 14FR
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901601805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Adventist Health Commercial |
$7.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.36
|
| Rate for Payer: Cash Price |
$20.03
|
| Rate for Payer: Cigna of CA HMO |
$23.30
|
| Rate for Payer: Cigna of CA PPO |
$26.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.56
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$30.95
|
| Rate for Payer: Global Benefits Group Commercial |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.49
|
| Rate for Payer: Multiplan Commercial |
$29.13
|
| Rate for Payer: Networks By Design Commercial |
$23.67
|
| Rate for Payer: Prime Health Services Commercial |
$30.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.20
|
| Rate for Payer: United Healthcare All Other HMO |
$18.20
|
| Rate for Payer: United Healthcare HMO Rider |
$18.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.95
|
|
|
HC CATH COUDE 18FR
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901601807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Adventist Health Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$20.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.56
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$30.95
|
| Rate for Payer: Global Benefits Group Commercial |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Multiplan Commercial |
$29.13
|
| Rate for Payer: Networks By Design Commercial |
$23.67
|
| Rate for Payer: Prime Health Services Commercial |
$30.95
|
|
|
HC CATH COUDE 18FR
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901601807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Adventist Health Commercial |
$7.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.36
|
| Rate for Payer: Cash Price |
$20.03
|
| Rate for Payer: Cigna of CA HMO |
$23.30
|
| Rate for Payer: Cigna of CA PPO |
$26.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.56
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$30.95
|
| Rate for Payer: Global Benefits Group Commercial |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.49
|
| Rate for Payer: Multiplan Commercial |
$29.13
|
| Rate for Payer: Networks By Design Commercial |
$23.67
|
| Rate for Payer: Prime Health Services Commercial |
$30.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.20
|
| Rate for Payer: United Healthcare All Other HMO |
$18.20
|
| Rate for Payer: United Healthcare HMO Rider |
$18.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.95
|
|
|
HC CATH COUDE 20FR
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901601808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Adventist Health Commercial |
$7.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.36
|
| Rate for Payer: Cash Price |
$20.03
|
| Rate for Payer: Cigna of CA HMO |
$23.30
|
| Rate for Payer: Cigna of CA PPO |
$26.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.56
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$30.95
|
| Rate for Payer: Global Benefits Group Commercial |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.49
|
| Rate for Payer: Multiplan Commercial |
$29.13
|
| Rate for Payer: Networks By Design Commercial |
$23.67
|
| Rate for Payer: Prime Health Services Commercial |
$30.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.20
|
| Rate for Payer: United Healthcare All Other HMO |
$18.20
|
| Rate for Payer: United Healthcare HMO Rider |
$18.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.95
|
|
|
HC CATH COUDE 20FR
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901601808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Adventist Health Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$20.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.56
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$30.95
|
| Rate for Payer: Global Benefits Group Commercial |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Multiplan Commercial |
$29.13
|
| Rate for Payer: Networks By Design Commercial |
$23.67
|
| Rate for Payer: Prime Health Services Commercial |
$30.95
|
|
|
HC CATH COUDE TIEMAN 16FR
|
Facility
|
IP
|
$38.54
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901601806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.42
|
| Rate for Payer: EPIC Health Plan Senior |
$15.42
|
| Rate for Payer: Galaxy Health WC |
$32.76
|
| Rate for Payer: Global Benefits Group Commercial |
$23.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Multiplan Commercial |
$30.83
|
| Rate for Payer: Networks By Design Commercial |
$25.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.76
|
|
|
HC CATH COUDE TIEMAN 16FR
|
Facility
|
OP
|
$38.54
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901601806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.67
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna of CA HMO |
$24.67
|
| Rate for Payer: Cigna of CA PPO |
$28.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.42
|
| Rate for Payer: EPIC Health Plan Senior |
$15.42
|
| Rate for Payer: Galaxy Health WC |
$32.76
|
| Rate for Payer: Global Benefits Group Commercial |
$23.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.98
|
| Rate for Payer: Multiplan Commercial |
$30.83
|
| Rate for Payer: Networks By Design Commercial |
$25.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.27
|
| Rate for Payer: United Healthcare HMO Rider |
$19.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.76
|
| Rate for Payer: Vantage Medical Group Senior |
$32.76
|
|
|
HC CATH COUDE TIP W G STRIP 12FR
|
Facility
|
OP
|
$47.89
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901607690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$40.71 |
| Rate for Payer: Adventist Health Commercial |
$9.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.41
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cigna of CA HMO |
$30.65
|
| Rate for Payer: Cigna of CA PPO |
$35.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.16
|
| Rate for Payer: EPIC Health Plan Senior |
$19.16
|
| Rate for Payer: Galaxy Health WC |
$40.71
|
| Rate for Payer: Global Benefits Group Commercial |
$28.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.52
|
| Rate for Payer: Multiplan Commercial |
$38.31
|
| Rate for Payer: Networks By Design Commercial |
$31.13
|
| Rate for Payer: Prime Health Services Commercial |
$40.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.95
|
| Rate for Payer: United Healthcare All Other HMO |
$23.95
|
| Rate for Payer: United Healthcare HMO Rider |
$23.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.71
|
| Rate for Payer: Vantage Medical Group Senior |
$40.71
|
|
|
HC CATH COUDE TIP W G STRIP 12FR
|
Facility
|
IP
|
$47.89
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901607690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$40.71 |
| Rate for Payer: Adventist Health Commercial |
$9.58
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.16
|
| Rate for Payer: EPIC Health Plan Senior |
$19.16
|
| Rate for Payer: Galaxy Health WC |
$40.71
|
| Rate for Payer: Global Benefits Group Commercial |
$28.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.49
|
| Rate for Payer: Multiplan Commercial |
$38.31
|
| Rate for Payer: Networks By Design Commercial |
$31.13
|
| Rate for Payer: Prime Health Services Commercial |
$40.71
|
|
|
HC CATH CRICOTHYROTOMY 3.5MM
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
901604422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Adventist Health Commercial |
$174.80
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$349.60
|
| Rate for Payer: EPIC Health Plan Senior |
$349.60
|
| Rate for Payer: Galaxy Health WC |
$742.90
|
| Rate for Payer: Global Benefits Group Commercial |
$524.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$582.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.76
|
| Rate for Payer: Multiplan Commercial |
$699.20
|
| Rate for Payer: Networks By Design Commercial |
$568.10
|
| Rate for Payer: Prime Health Services Commercial |
$742.90
|
|
|
HC CATH CRICOTHYROTOMY 3.5MM
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
901604422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Adventist Health Commercial |
$174.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$573.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$742.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$480.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$655.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$536.72
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: Cigna of CA HMO |
$559.36
|
| Rate for Payer: Cigna of CA PPO |
$646.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$742.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$742.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$349.60
|
| Rate for Payer: EPIC Health Plan Senior |
$349.60
|
| Rate for Payer: Galaxy Health WC |
$742.90
|
| Rate for Payer: Global Benefits Group Commercial |
$524.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$582.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$611.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$611.80
|
| Rate for Payer: Multiplan Commercial |
$699.20
|
| Rate for Payer: Networks By Design Commercial |
$568.10
|
| Rate for Payer: Prime Health Services Commercial |
$742.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$524.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$524.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$437.00
|
| Rate for Payer: United Healthcare All Other HMO |
$437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$437.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$437.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$742.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.90
|
| Rate for Payer: Vantage Medical Group Senior |
$742.90
|
|
|
HC CATH CRICOTHYROTOMY ADULT
|
Facility
|
IP
|
$963.19
|
|
| Hospital Charge Code |
901602640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.64 |
| Max. Negotiated Rate |
$818.71 |
| Rate for Payer: Adventist Health Commercial |
$192.64
|
| Rate for Payer: Cash Price |
$529.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.28
|
| Rate for Payer: EPIC Health Plan Senior |
$385.28
|
| Rate for Payer: Galaxy Health WC |
$818.71
|
| Rate for Payer: Global Benefits Group Commercial |
$577.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.17
|
| Rate for Payer: Multiplan Commercial |
$770.55
|
| Rate for Payer: Networks By Design Commercial |
$626.07
|
| Rate for Payer: Prime Health Services Commercial |
$818.71
|
|
|
HC CATH CRICOTHYROTOMY ADULT
|
Facility
|
OP
|
$963.19
|
|
| Hospital Charge Code |
901602640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.64 |
| Max. Negotiated Rate |
$818.71 |
| Rate for Payer: Adventist Health Commercial |
$192.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$631.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$818.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$591.49
|
| Rate for Payer: Cash Price |
$529.75
|
| Rate for Payer: Cigna of CA HMO |
$616.44
|
| Rate for Payer: Cigna of CA PPO |
$712.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$818.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$818.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$818.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.28
|
| Rate for Payer: EPIC Health Plan Senior |
$385.28
|
| Rate for Payer: Galaxy Health WC |
$818.71
|
| Rate for Payer: Global Benefits Group Commercial |
$577.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.23
|
| Rate for Payer: Multiplan Commercial |
$770.55
|
| Rate for Payer: Networks By Design Commercial |
$626.07
|
| Rate for Payer: Prime Health Services Commercial |
$818.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$577.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.60
|
| Rate for Payer: United Healthcare All Other HMO |
$481.60
|
| Rate for Payer: United Healthcare HMO Rider |
$481.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$481.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$818.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$818.71
|
| Rate for Payer: Vantage Medical Group Senior |
$818.71
|
|
|
HC CATH CV 7FR 6" TL FULL TRAY
|
Facility
|
OP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$514.67 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.71
|
| Rate for Payer: Blue Shield of California Commercial |
$446.86
|
| Rate for Payer: Blue Shield of California EPN |
$294.27
|
| Rate for Payer: Cash Price |
$333.03
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.85
|
| Rate for Payer: Multiplan Commercial |
$484.40
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.67
|
| Rate for Payer: Vantage Medical Group Senior |
$514.67
|
|
|
HC CATH CV 7FR 6" TL FULL TRAY
|
Facility
|
IP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$333.03
|
| Rate for Payer: Cash Price |
$333.03
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.32
|
| Rate for Payer: Multiplan Commercial |
$484.40
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
|
|
HC CATH CV 7FR 8" TL FULL TRAY
|
Facility
|
IP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$333.03
|
| Rate for Payer: Cash Price |
$333.03
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.32
|
| Rate for Payer: Multiplan Commercial |
$484.40
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
|
|
HC CATH CV 7FR 8" TL FULL TRAY
|
Facility
|
OP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$514.67 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.71
|
| Rate for Payer: Blue Shield of California Commercial |
$446.86
|
| Rate for Payer: Blue Shield of California EPN |
$294.27
|
| Rate for Payer: Cash Price |
$333.03
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.85
|
| Rate for Payer: Multiplan Commercial |
$484.40
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.67
|
| Rate for Payer: Vantage Medical Group Senior |
$514.67
|
|
|
HC CATH CV 8FR 6" DL FULL TRAY
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.94
|
| Rate for Payer: Blue Shield of California Commercial |
$428.04
|
| Rate for Payer: Blue Shield of California EPN |
$281.88
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CATH CV 8FR 6" DL FULL TRAY
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED
|
Facility
|
OP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$663.14 |
| Rate for Payer: Adventist Health Commercial |
$156.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.87
|
| Rate for Payer: Blue Shield of California Commercial |
$575.76
|
| Rate for Payer: Blue Shield of California EPN |
$379.16
|
| Rate for Payer: Cash Price |
$429.09
|
| Rate for Payer: Cigna of CA HMO |
$546.11
|
| Rate for Payer: Cigna of CA PPO |
$546.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.06
|
| Rate for Payer: EPIC Health Plan Senior |
$312.06
|
| Rate for Payer: Galaxy Health WC |
$663.14
|
| Rate for Payer: Global Benefits Group Commercial |
$468.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$546.11
|
| Rate for Payer: Multiplan Commercial |
$624.13
|
| Rate for Payer: Networks By Design Commercial |
$390.08
|
| Rate for Payer: Prime Health Services Commercial |
$663.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.79
|
| Rate for Payer: United Healthcare All Other HMO |
$284.99
|
| Rate for Payer: United Healthcare HMO Rider |
$278.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.14
|
| Rate for Payer: Vantage Medical Group Senior |
$663.14
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED
|
Facility
|
IP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$156.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$429.09
|
| Rate for Payer: Cash Price |
$429.09
|
| Rate for Payer: Cigna of CA HMO |
$546.11
|
| Rate for Payer: Cigna of CA PPO |
$546.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.06
|
| Rate for Payer: EPIC Health Plan Senior |
$312.06
|
| Rate for Payer: Galaxy Health WC |
$663.14
|
| Rate for Payer: Global Benefits Group Commercial |
$468.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.24
|
| Rate for Payer: Multiplan Commercial |
$624.13
|
| Rate for Payer: Networks By Design Commercial |
$390.08
|
| Rate for Payer: Prime Health Services Commercial |
$663.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.79
|
| Rate for Payer: United Healthcare All Other HMO |
$284.99
|
| Rate for Payer: United Healthcare HMO Rider |
$278.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.50
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED LEG
|
Facility
|
IP
|
$1,030.12
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.02 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$206.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$566.57
|
| Rate for Payer: Cash Price |
$566.57
|
| Rate for Payer: Cigna of CA HMO |
$721.08
|
| Rate for Payer: Cigna of CA PPO |
$721.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.05
|
| Rate for Payer: EPIC Health Plan Senior |
$412.05
|
| Rate for Payer: Galaxy Health WC |
$875.60
|
| Rate for Payer: Global Benefits Group Commercial |
$618.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$637.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.23
|
| Rate for Payer: Multiplan Commercial |
$824.10
|
| Rate for Payer: Networks By Design Commercial |
$515.06
|
| Rate for Payer: Prime Health Services Commercial |
$875.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.60
|
| Rate for Payer: United Healthcare All Other HMO |
$376.30
|
| Rate for Payer: United Healthcare HMO Rider |
$368.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.36
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED LEG
|
Facility
|
OP
|
$1,030.12
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.02 |
| Max. Negotiated Rate |
$875.60 |
| Rate for Payer: Adventist Health Commercial |
$206.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$875.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$772.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$596.65
|
| Rate for Payer: Blue Shield of California Commercial |
$760.23
|
| Rate for Payer: Blue Shield of California EPN |
$500.64
|
| Rate for Payer: Cash Price |
$566.57
|
| Rate for Payer: Cigna of CA HMO |
$721.08
|
| Rate for Payer: Cigna of CA PPO |
$721.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$875.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$875.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$875.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.05
|
| Rate for Payer: EPIC Health Plan Senior |
$412.05
|
| Rate for Payer: Galaxy Health WC |
$875.60
|
| Rate for Payer: Global Benefits Group Commercial |
$618.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$637.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$721.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$721.08
|
| Rate for Payer: Multiplan Commercial |
$824.10
|
| Rate for Payer: Networks By Design Commercial |
$515.06
|
| Rate for Payer: Prime Health Services Commercial |
$875.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$618.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.60
|
| Rate for Payer: United Healthcare All Other HMO |
$376.30
|
| Rate for Payer: United Healthcare HMO Rider |
$368.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$875.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$875.60
|
| Rate for Payer: Vantage Medical Group Senior |
$875.60
|
|
