|
HC CATH DIALYSIS 13FR 20CM TRIALYSIS STRAIGHT LEG
|
Facility
|
OP
|
$976.95
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$830.41 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$537.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$732.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.85
|
| Rate for Payer: Blue Shield of California Commercial |
$720.99
|
| Rate for Payer: Blue Shield of California EPN |
$474.80
|
| Rate for Payer: Cash Price |
$439.63
|
| Rate for Payer: Cigna of CA HMO |
$683.87
|
| Rate for Payer: Cigna of CA PPO |
$683.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$830.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$830.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.78
|
| Rate for Payer: EPIC Health Plan Senior |
$390.78
|
| Rate for Payer: Galaxy Health WC |
$830.41
|
| Rate for Payer: Global Benefits Group Commercial |
$586.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$651.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$604.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.87
|
| Rate for Payer: Multiplan Commercial |
$781.56
|
| Rate for Payer: Networks By Design Commercial |
$488.48
|
| Rate for Payer: Prime Health Services Commercial |
$830.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.65
|
| Rate for Payer: United Healthcare All Other HMO |
$356.88
|
| Rate for Payer: United Healthcare HMO Rider |
$349.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$830.41
|
| Rate for Payer: Vantage Medical Group Senior |
$830.41
|
|
|
HC CATH DIALYSIS 13FR 20CM TRIALYSIS STRAIGHT LEG
|
Facility
|
IP
|
$976.95
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$439.63
|
| Rate for Payer: Cash Price |
$439.63
|
| Rate for Payer: Cigna of CA HMO |
$683.87
|
| Rate for Payer: Cigna of CA PPO |
$683.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.78
|
| Rate for Payer: EPIC Health Plan Senior |
$390.78
|
| Rate for Payer: Galaxy Health WC |
$830.41
|
| Rate for Payer: Global Benefits Group Commercial |
$586.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$651.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$604.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.47
|
| Rate for Payer: Multiplan Commercial |
$781.56
|
| Rate for Payer: Networks By Design Commercial |
$488.48
|
| Rate for Payer: Prime Health Services Commercial |
$830.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.65
|
| Rate for Payer: United Healthcare All Other HMO |
$356.88
|
| Rate for Payer: United Healthcare HMO Rider |
$349.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.95
|
|
|
HC CATH DIALYSIS 13FR 24CM KIT
|
Facility
|
IP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698110
|
|
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 |
$351.07
|
| Rate for Payer: Cash Price |
$351.07
|
| 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 24CM KIT
|
Facility
|
OP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698110
|
|
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 |
$351.07
|
| 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 24CM TRIALYSIS STRAIGHT
|
Facility
|
IP
|
$976.95
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$439.63
|
| Rate for Payer: Cash Price |
$439.63
|
| Rate for Payer: Cigna of CA HMO |
$683.87
|
| Rate for Payer: Cigna of CA PPO |
$683.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.78
|
| Rate for Payer: EPIC Health Plan Senior |
$390.78
|
| Rate for Payer: Galaxy Health WC |
$830.41
|
| Rate for Payer: Global Benefits Group Commercial |
$586.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$651.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$604.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.47
|
| Rate for Payer: Multiplan Commercial |
$781.56
|
| Rate for Payer: Networks By Design Commercial |
$488.48
|
| Rate for Payer: Prime Health Services Commercial |
$830.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.65
|
| Rate for Payer: United Healthcare All Other HMO |
$356.88
|
| Rate for Payer: United Healthcare HMO Rider |
$349.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.95
|
|
|
HC CATH DIALYSIS 13FR 24CM TRIALYSIS STRAIGHT
|
Facility
|
OP
|
$976.95
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$830.41 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$537.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$732.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.85
|
| Rate for Payer: Blue Shield of California Commercial |
$720.99
|
| Rate for Payer: Blue Shield of California EPN |
$474.80
|
| Rate for Payer: Cash Price |
$439.63
|
| Rate for Payer: Cigna of CA HMO |
$683.87
|
| Rate for Payer: Cigna of CA PPO |
$683.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$830.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$830.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.78
|
| Rate for Payer: EPIC Health Plan Senior |
$390.78
|
| Rate for Payer: Galaxy Health WC |
$830.41
|
| Rate for Payer: Global Benefits Group Commercial |
$586.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$651.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$604.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.87
|
| Rate for Payer: Multiplan Commercial |
$781.56
|
| Rate for Payer: Networks By Design Commercial |
$488.48
|
| Rate for Payer: Prime Health Services Commercial |
$830.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.65
|
| Rate for Payer: United Healthcare All Other HMO |
$356.88
|
| Rate for Payer: United Healthcare HMO Rider |
$349.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$830.41
|
| Rate for Payer: Vantage Medical Group Senior |
$830.41
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
OP
|
$33,690.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,510.17 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,738.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$15,160.50
|
| Rate for Payer: Cash Price |
$15,160.50
|
| Rate for Payer: Cash Price |
$15,160.50
|
| Rate for Payer: Cigna of CA HMO |
$21,561.60
|
| Rate for Payer: Cigna of CA PPO |
$24,930.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$28,636.50
|
| Rate for Payer: Global Benefits Group Commercial |
$20,214.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,471.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,832.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,085.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$26,952.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$21,898.50
|
| Rate for Payer: Prime Health Services Commercial |
$28,636.50
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,214.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
IP
|
$33,690.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,738.00 |
| Max. Negotiated Rate |
$28,636.50 |
| Rate for Payer: Adventist Health Commercial |
$6,738.00
|
| Rate for Payer: Cash Price |
$15,160.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,476.00
|
| Rate for Payer: Galaxy Health WC |
$28,636.50
|
| Rate for Payer: Global Benefits Group Commercial |
$20,214.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,471.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,835.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,854.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,085.60
|
| Rate for Payer: Multiplan Commercial |
$26,952.00
|
| Rate for Payer: Networks By Design Commercial |
$21,898.50
|
| Rate for Payer: Prime Health Services Commercial |
$28,636.50
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
OP
|
$14,211.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
906820281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,868.26 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,842.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$6,394.95
|
| Rate for Payer: Cash Price |
$6,394.95
|
| Rate for Payer: Cash Price |
$6,394.95
|
| Rate for Payer: Cigna of CA HMO |
$9,095.04
|
| Rate for Payer: Cigna of CA PPO |
$10,516.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$12,079.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,526.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,868.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,478.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,112.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,410.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$11,368.80
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$9,237.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,079.35
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,526.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
OP
|
$14,622.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,868.26 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,924.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$6,579.90
|
| Rate for Payer: Cash Price |
$6,579.90
|
| Rate for Payer: Cash Price |
$6,579.90
|
| Rate for Payer: Cigna of CA HMO |
$9,358.08
|
| Rate for Payer: Cigna of CA PPO |
$10,820.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$12,428.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,773.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,868.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,752.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,112.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,509.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$11,697.60
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$9,504.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,428.70
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,773.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
IP
|
$14,622.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,924.40 |
| Max. Negotiated Rate |
$12,428.70 |
| Rate for Payer: Adventist Health Commercial |
$2,924.40
|
| Rate for Payer: Cash Price |
$6,579.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,848.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,848.80
|
| Rate for Payer: Galaxy Health WC |
$12,428.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,773.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,752.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,570.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,051.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,509.28
|
| Rate for Payer: Multiplan Commercial |
$11,697.60
|
| Rate for Payer: Networks By Design Commercial |
$9,504.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,428.70
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
IP
|
$14,211.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
906820281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,842.20 |
| Max. Negotiated Rate |
$12,079.35 |
| Rate for Payer: Adventist Health Commercial |
$2,842.20
|
| Rate for Payer: Cash Price |
$6,394.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,684.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,684.40
|
| Rate for Payer: Galaxy Health WC |
$12,079.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,526.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,478.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,414.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,796.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,410.64
|
| Rate for Payer: Multiplan Commercial |
$11,368.80
|
| Rate for Payer: Networks By Design Commercial |
$9,237.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,079.35
|
|
|
HC CATH DIALYSIS TRAY 2LUMEN 13FR
|
Facility
|
IP
|
$2,326.66
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.33 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$465.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna of CA HMO |
$1,628.66
|
| Rate for Payer: Cigna of CA PPO |
$1,628.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.66
|
| Rate for Payer: EPIC Health Plan Senior |
$930.66
|
| Rate for Payer: Galaxy Health WC |
$1,977.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,551.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,440.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.40
|
| Rate for Payer: Multiplan Commercial |
$1,861.33
|
| Rate for Payer: Networks By Design Commercial |
$1,163.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,977.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$873.20
|
| Rate for Payer: United Healthcare All Other HMO |
$849.93
|
| Rate for Payer: United Healthcare HMO Rider |
$831.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.98
|
|
|
HC CATH DIALYSIS TRAY 2LUMEN 13FR
|
Facility
|
OP
|
$2,326.66
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.33 |
| Max. Negotiated Rate |
$1,977.66 |
| Rate for Payer: Adventist Health Commercial |
$465.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,977.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,279.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,744.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,347.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,717.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,130.76
|
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna of CA HMO |
$1,628.66
|
| Rate for Payer: Cigna of CA PPO |
$1,628.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,977.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,977.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,977.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.66
|
| Rate for Payer: EPIC Health Plan Senior |
$930.66
|
| Rate for Payer: Galaxy Health WC |
$1,977.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,551.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,440.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,628.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,628.66
|
| Rate for Payer: Multiplan Commercial |
$1,861.33
|
| Rate for Payer: Networks By Design Commercial |
$1,163.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,977.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,396.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,396.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$873.20
|
| Rate for Payer: United Healthcare All Other HMO |
$849.93
|
| Rate for Payer: United Healthcare HMO Rider |
$831.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,977.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,977.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,977.66
|
|
|
HC CATH DRAIN EXTERNAL
|
Facility
|
OP
|
$884.86
|
|
| Hospital Charge Code |
901602815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.97 |
| Max. Negotiated Rate |
$752.13 |
| Rate for Payer: Adventist Health Commercial |
$176.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$580.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$752.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$486.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$663.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$543.39
|
| Rate for Payer: Cash Price |
$398.19
|
| Rate for Payer: Cigna of CA HMO |
$566.31
|
| Rate for Payer: Cigna of CA PPO |
$654.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$752.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$752.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.94
|
| Rate for Payer: EPIC Health Plan Senior |
$353.94
|
| Rate for Payer: Galaxy Health WC |
$752.13
|
| Rate for Payer: Global Benefits Group Commercial |
$530.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$547.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$619.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$619.40
|
| Rate for Payer: Multiplan Commercial |
$707.89
|
| Rate for Payer: Networks By Design Commercial |
$575.16
|
| Rate for Payer: Prime Health Services Commercial |
$752.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$530.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$530.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$442.43
|
| Rate for Payer: United Healthcare All Other HMO |
$442.43
|
| Rate for Payer: United Healthcare HMO Rider |
$442.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$752.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.13
|
| Rate for Payer: Vantage Medical Group Senior |
$752.13
|
|
|
HC CATH DRAIN EXTERNAL
|
Facility
|
IP
|
$884.86
|
|
| Hospital Charge Code |
901602815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.97 |
| Max. Negotiated Rate |
$752.13 |
| Rate for Payer: Adventist Health Commercial |
$176.97
|
| Rate for Payer: Cash Price |
$398.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.94
|
| Rate for Payer: EPIC Health Plan Senior |
$353.94
|
| Rate for Payer: Galaxy Health WC |
$752.13
|
| Rate for Payer: Global Benefits Group Commercial |
$530.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$547.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.37
|
| Rate for Payer: Multiplan Commercial |
$707.89
|
| Rate for Payer: Networks By Design Commercial |
$575.16
|
| Rate for Payer: Prime Health Services Commercial |
$752.13
|
|
|
HC CATH DRAIN LUMBAR INTGRA 80CM
|
Facility
|
OP
|
$759.05
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901604190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.81 |
| Max. Negotiated Rate |
$645.19 |
| Rate for Payer: Adventist Health Commercial |
$151.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$645.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$439.64
|
| Rate for Payer: Blue Shield of California Commercial |
$560.18
|
| Rate for Payer: Blue Shield of California EPN |
$368.90
|
| Rate for Payer: Cash Price |
$341.57
|
| Rate for Payer: Cigna of CA HMO |
$531.34
|
| Rate for Payer: Cigna of CA PPO |
$531.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$645.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$645.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$645.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.62
|
| Rate for Payer: EPIC Health Plan Senior |
$303.62
|
| Rate for Payer: Galaxy Health WC |
$645.19
|
| Rate for Payer: Global Benefits Group Commercial |
$455.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.34
|
| Rate for Payer: Multiplan Commercial |
$607.24
|
| Rate for Payer: Networks By Design Commercial |
$379.52
|
| Rate for Payer: Prime Health Services Commercial |
$645.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.87
|
| Rate for Payer: United Healthcare All Other HMO |
$277.28
|
| Rate for Payer: United Healthcare HMO Rider |
$271.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$645.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.19
|
| Rate for Payer: Vantage Medical Group Senior |
$645.19
|
|
|
HC CATH DRAIN LUMBAR INTGRA 80CM
|
Facility
|
IP
|
$759.05
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901604190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.81 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$151.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$341.57
|
| Rate for Payer: Cash Price |
$341.57
|
| Rate for Payer: Cigna of CA HMO |
$531.34
|
| Rate for Payer: Cigna of CA PPO |
$531.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.62
|
| Rate for Payer: EPIC Health Plan Senior |
$303.62
|
| Rate for Payer: Galaxy Health WC |
$645.19
|
| Rate for Payer: Global Benefits Group Commercial |
$455.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.17
|
| Rate for Payer: Multiplan Commercial |
$607.24
|
| Rate for Payer: Networks By Design Commercial |
$379.52
|
| Rate for Payer: Prime Health Services Commercial |
$645.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.87
|
| Rate for Payer: United Healthcare All Other HMO |
$277.28
|
| Rate for Payer: United Healthcare HMO Rider |
$271.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.59
|
|
|
HC CATH DRAIN PER-Q CAVTY 14FR*
|
Facility
|
OP
|
$622.66
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901603300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.53 |
| Max. Negotiated Rate |
$529.26 |
| Rate for Payer: Adventist Health Commercial |
$124.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$529.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$467.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.64
|
| Rate for Payer: Blue Shield of California Commercial |
$459.52
|
| Rate for Payer: Blue Shield of California EPN |
$302.61
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna of CA HMO |
$435.86
|
| Rate for Payer: Cigna of CA PPO |
$435.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$529.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$529.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.06
|
| Rate for Payer: EPIC Health Plan Senior |
$249.06
|
| Rate for Payer: Galaxy Health WC |
$529.26
|
| Rate for Payer: Global Benefits Group Commercial |
$373.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$415.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.86
|
| Rate for Payer: Multiplan Commercial |
$498.13
|
| Rate for Payer: Networks By Design Commercial |
$311.33
|
| Rate for Payer: Prime Health Services Commercial |
$529.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$373.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$373.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.68
|
| Rate for Payer: United Healthcare All Other HMO |
$227.46
|
| Rate for Payer: United Healthcare HMO Rider |
$222.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$529.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.26
|
| Rate for Payer: Vantage Medical Group Senior |
$529.26
|
|
|
HC CATH DRAIN PER-Q CAVTY 14FR*
|
Facility
|
IP
|
$622.66
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901603300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.53 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$124.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna of CA HMO |
$435.86
|
| Rate for Payer: Cigna of CA PPO |
$435.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.06
|
| Rate for Payer: EPIC Health Plan Senior |
$249.06
|
| Rate for Payer: Galaxy Health WC |
$529.26
|
| Rate for Payer: Global Benefits Group Commercial |
$373.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$415.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.44
|
| Rate for Payer: Multiplan Commercial |
$498.13
|
| Rate for Payer: Networks By Design Commercial |
$311.33
|
| Rate for Payer: Prime Health Services Commercial |
$529.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.68
|
| Rate for Payer: United Healthcare All Other HMO |
$227.46
|
| Rate for Payer: United Healthcare HMO Rider |
$222.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.92
|
|
|
HC CATH DRAIN PNEUMOPERIC 5FR
|
Facility
|
OP
|
$590.18
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901604780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.04 |
| Max. Negotiated Rate |
$501.65 |
| Rate for Payer: Adventist Health Commercial |
$118.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$387.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$501.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$442.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.43
|
| Rate for Payer: Cash Price |
$265.58
|
| Rate for Payer: Cigna of CA HMO |
$377.72
|
| Rate for Payer: Cigna of CA PPO |
$436.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$501.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$501.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.07
|
| Rate for Payer: EPIC Health Plan Senior |
$236.07
|
| Rate for Payer: Galaxy Health WC |
$501.65
|
| Rate for Payer: Global Benefits Group Commercial |
$354.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$393.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.13
|
| Rate for Payer: Multiplan Commercial |
$472.14
|
| Rate for Payer: Networks By Design Commercial |
$383.62
|
| Rate for Payer: Prime Health Services Commercial |
$501.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.09
|
| Rate for Payer: United Healthcare All Other HMO |
$295.09
|
| Rate for Payer: United Healthcare HMO Rider |
$295.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$501.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$501.65
|
| Rate for Payer: Vantage Medical Group Senior |
$501.65
|
|
|
HC CATH DRAIN PNEUMOPERIC 5FR
|
Facility
|
IP
|
$590.18
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901604780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.04 |
| Max. Negotiated Rate |
$501.65 |
| Rate for Payer: Adventist Health Commercial |
$118.04
|
| Rate for Payer: Cash Price |
$265.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.07
|
| Rate for Payer: EPIC Health Plan Senior |
$236.07
|
| Rate for Payer: Galaxy Health WC |
$501.65
|
| Rate for Payer: Global Benefits Group Commercial |
$354.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$393.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.64
|
| Rate for Payer: Multiplan Commercial |
$472.14
|
| Rate for Payer: Networks By Design Commercial |
$383.62
|
| Rate for Payer: Prime Health Services Commercial |
$501.65
|
|
|
HC CATH DRAIN SET PNEUMOPERIC 6FR
|
Facility
|
OP
|
$604.44
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.89 |
| Max. Negotiated Rate |
$513.77 |
| Rate for Payer: Adventist Health Commercial |
$120.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$513.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.19
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna of CA HMO |
$386.84
|
| Rate for Payer: Cigna of CA PPO |
$447.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$513.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$513.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$513.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.78
|
| Rate for Payer: EPIC Health Plan Senior |
$241.78
|
| Rate for Payer: Galaxy Health WC |
$513.77
|
| Rate for Payer: Global Benefits Group Commercial |
$362.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.11
|
| Rate for Payer: Multiplan Commercial |
$483.55
|
| Rate for Payer: Networks By Design Commercial |
$392.89
|
| Rate for Payer: Prime Health Services Commercial |
$513.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$362.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$362.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.22
|
| Rate for Payer: United Healthcare All Other HMO |
$302.22
|
| Rate for Payer: United Healthcare HMO Rider |
$302.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$302.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$513.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$513.77
|
| Rate for Payer: Vantage Medical Group Senior |
$513.77
|
|
|
HC CATH DRAIN SET PNEUMOPERIC 6FR
|
Facility
|
IP
|
$604.44
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.89 |
| Max. Negotiated Rate |
$513.77 |
| Rate for Payer: Adventist Health Commercial |
$120.89
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.78
|
| Rate for Payer: EPIC Health Plan Senior |
$241.78
|
| Rate for Payer: Galaxy Health WC |
$513.77
|
| Rate for Payer: Global Benefits Group Commercial |
$362.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.07
|
| Rate for Payer: Multiplan Commercial |
$483.55
|
| Rate for Payer: Networks By Design Commercial |
$392.89
|
| Rate for Payer: Prime Health Services Commercial |
$513.77
|
|
|
HC CATH EDWARDS MONITOR BAL
|
Facility
|
IP
|
$301.77
|
|
| Hospital Charge Code |
906812008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Adventist Health Commercial |
$60.35
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.71
|
| Rate for Payer: EPIC Health Plan Senior |
$120.71
|
| Rate for Payer: Galaxy Health WC |
$256.50
|
| Rate for Payer: Global Benefits Group Commercial |
$181.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.42
|
| Rate for Payer: Multiplan Commercial |
$241.42
|
| Rate for Payer: Networks By Design Commercial |
$196.15
|
| Rate for Payer: Prime Health Services Commercial |
$256.50
|
|
