|
HC CATH LO-FRIC PRIMO FML 16FR
|
Facility
|
IP
|
$30.09
|
|
| Hospital Charge Code |
901605907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$25.58 |
| Rate for Payer: Adventist Health Commercial |
$6.02
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.04
|
| Rate for Payer: EPIC Health Plan Senior |
$12.04
|
| Rate for Payer: Galaxy Health WC |
$25.58
|
| Rate for Payer: Global Benefits Group Commercial |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$24.07
|
| Rate for Payer: Networks By Design Commercial |
$19.56
|
| Rate for Payer: Prime Health Services Commercial |
$25.58
|
|
|
HC CATH LO-FRIC PRIMO FML 16FR
|
Facility
|
IP
|
$11.48
|
|
| Hospital Charge Code |
901605835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: Adventist Health Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.59
|
| Rate for Payer: EPIC Health Plan Senior |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$9.76
|
| Rate for Payer: Global Benefits Group Commercial |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
| Rate for Payer: Networks By Design Commercial |
$7.46
|
| Rate for Payer: Prime Health Services Commercial |
$9.76
|
|
|
HC CATH LO-FRIC PRIMO FML 16FR
|
Facility
|
OP
|
$32.23
|
|
| Hospital Charge Code |
901605906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Adventist Health Commercial |
$6.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.79
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cigna of CA HMO |
$20.63
|
| Rate for Payer: Cigna of CA PPO |
$23.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.89
|
| Rate for Payer: EPIC Health Plan Senior |
$12.89
|
| Rate for Payer: Galaxy Health WC |
$27.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$25.78
|
| Rate for Payer: Networks By Design Commercial |
$20.95
|
| Rate for Payer: Prime Health Services Commercial |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.11
|
| Rate for Payer: United Healthcare All Other HMO |
$16.11
|
| Rate for Payer: United Healthcare HMO Rider |
$16.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$27.40
|
|
|
HC CATH LO-FRIC PRIMO FML 16FR
|
Facility
|
OP
|
$30.09
|
|
| Hospital Charge Code |
901605907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$25.58 |
| Rate for Payer: Adventist Health Commercial |
$6.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.48
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Cigna of CA HMO |
$19.26
|
| Rate for Payer: Cigna of CA PPO |
$22.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.04
|
| Rate for Payer: EPIC Health Plan Senior |
$12.04
|
| Rate for Payer: Galaxy Health WC |
$25.58
|
| Rate for Payer: Global Benefits Group Commercial |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$24.07
|
| Rate for Payer: Networks By Design Commercial |
$19.56
|
| Rate for Payer: Prime Health Services Commercial |
$25.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.04
|
| Rate for Payer: United Healthcare All Other HMO |
$15.04
|
| Rate for Payer: United Healthcare HMO Rider |
$15.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.58
|
| Rate for Payer: Vantage Medical Group Senior |
$25.58
|
|
|
HC CATH LO-FRIC PRIMO FML 16FR
|
Facility
|
IP
|
$32.23
|
|
| Hospital Charge Code |
901605906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Adventist Health Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.89
|
| Rate for Payer: EPIC Health Plan Senior |
$12.89
|
| Rate for Payer: Galaxy Health WC |
$27.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.74
|
| Rate for Payer: Multiplan Commercial |
$25.78
|
| Rate for Payer: Networks By Design Commercial |
$20.95
|
| Rate for Payer: Prime Health Services Commercial |
$27.40
|
|
|
HC CATH LO-FRIC PRIMO FML 16FR
|
Facility
|
IP
|
$32.23
|
|
| Hospital Charge Code |
901605908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Adventist Health Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.89
|
| Rate for Payer: EPIC Health Plan Senior |
$12.89
|
| Rate for Payer: Galaxy Health WC |
$27.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.74
|
| Rate for Payer: Multiplan Commercial |
$25.78
|
| Rate for Payer: Networks By Design Commercial |
$20.95
|
| Rate for Payer: Prime Health Services Commercial |
$27.40
|
|
|
HC CATH LO-FRI PRIMO 14FR
|
Facility
|
OP
|
$10.91
|
|
| Hospital Charge Code |
901605824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Adventist Health Commercial |
$2.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.70
|
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: Cigna of CA HMO |
$6.98
|
| Rate for Payer: Cigna of CA PPO |
$8.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: EPIC Health Plan Senior |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.27
|
| Rate for Payer: Global Benefits Group Commercial |
$6.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.64
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.09
|
| Rate for Payer: Prime Health Services Commercial |
$9.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other HMO |
$5.46
|
| Rate for Payer: United Healthcare HMO Rider |
$5.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.27
|
|
|
HC CATH LO-FRI PRIMO 14FR
|
Facility
|
IP
|
$10.91
|
|
| Hospital Charge Code |
901605824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Adventist Health Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: EPIC Health Plan Senior |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.27
|
| Rate for Payer: Global Benefits Group Commercial |
$6.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.09
|
| Rate for Payer: Prime Health Services Commercial |
$9.27
|
|
|
HC CATH MAGIC 3 INTMT 12FR FEMALE
|
Facility
|
OP
|
$11.07
|
|
| Hospital Charge Code |
901698146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.80
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$7.08
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5.54
|
| Rate for Payer: United Healthcare HMO Rider |
$5.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.41
|
| Rate for Payer: Vantage Medical Group Senior |
$9.41
|
|
|
HC CATH MAGIC 3 INTMT 12FR FEMALE
|
Facility
|
IP
|
$11.07
|
|
| Hospital Charge Code |
901698146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
|
|
HC CATH MAHURKAR 10FR 12MM DBL
|
Facility
|
IP
|
$446.89
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$201.10
|
| Rate for Payer: Cash Price |
$201.10
|
| Rate for Payer: Cigna of CA HMO |
$312.82
|
| Rate for Payer: Cigna of CA PPO |
$312.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.76
|
| Rate for Payer: EPIC Health Plan Senior |
$178.76
|
| Rate for Payer: Galaxy Health WC |
$379.86
|
| Rate for Payer: Global Benefits Group Commercial |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$276.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$357.51
|
| Rate for Payer: Networks By Design Commercial |
$223.44
|
| Rate for Payer: Prime Health Services Commercial |
$379.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.72
|
| Rate for Payer: United Healthcare All Other HMO |
$163.25
|
| Rate for Payer: United Healthcare HMO Rider |
$159.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.36
|
|
|
HC CATH MAHURKAR 10FR 12MM DBL
|
Facility
|
OP
|
$446.89
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$379.86 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$379.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$245.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.84
|
| Rate for Payer: Blue Shield of California Commercial |
$329.80
|
| Rate for Payer: Blue Shield of California EPN |
$217.19
|
| Rate for Payer: Cash Price |
$201.10
|
| Rate for Payer: Cigna of CA HMO |
$312.82
|
| Rate for Payer: Cigna of CA PPO |
$312.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$379.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$379.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.76
|
| Rate for Payer: EPIC Health Plan Senior |
$178.76
|
| Rate for Payer: Galaxy Health WC |
$379.86
|
| Rate for Payer: Global Benefits Group Commercial |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$276.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$312.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$312.82
|
| Rate for Payer: Multiplan Commercial |
$357.51
|
| Rate for Payer: Networks By Design Commercial |
$223.44
|
| Rate for Payer: Prime Health Services Commercial |
$379.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.72
|
| Rate for Payer: United Healthcare All Other HMO |
$163.25
|
| Rate for Payer: United Healthcare HMO Rider |
$159.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$379.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$379.86
|
| Rate for Payer: Vantage Medical Group Senior |
$379.86
|
|
|
HC CATH MAHURKAR 11.5FR 13.5 CM
|
Facility
|
OP
|
$447.76
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$380.60 |
| Rate for Payer: Adventist Health Commercial |
$89.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.34
|
| Rate for Payer: Blue Shield of California Commercial |
$330.45
|
| Rate for Payer: Blue Shield of California EPN |
$217.61
|
| Rate for Payer: Cash Price |
$201.49
|
| Rate for Payer: Cigna of CA HMO |
$313.43
|
| Rate for Payer: Cigna of CA PPO |
$313.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$380.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.10
|
| Rate for Payer: EPIC Health Plan Senior |
$179.10
|
| Rate for Payer: Galaxy Health WC |
$380.60
|
| Rate for Payer: Global Benefits Group Commercial |
$268.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.43
|
| Rate for Payer: Multiplan Commercial |
$358.21
|
| Rate for Payer: Networks By Design Commercial |
$223.88
|
| Rate for Payer: Prime Health Services Commercial |
$380.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.04
|
| Rate for Payer: United Healthcare All Other HMO |
$163.57
|
| Rate for Payer: United Healthcare HMO Rider |
$160.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.60
|
| Rate for Payer: Vantage Medical Group Senior |
$380.60
|
|
|
HC CATH MAHURKAR 11.5FR 13.5 CM
|
Facility
|
IP
|
$447.76
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$89.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$201.49
|
| Rate for Payer: Cash Price |
$201.49
|
| Rate for Payer: Cigna of CA HMO |
$313.43
|
| Rate for Payer: Cigna of CA PPO |
$313.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.10
|
| Rate for Payer: EPIC Health Plan Senior |
$179.10
|
| Rate for Payer: Galaxy Health WC |
$380.60
|
| Rate for Payer: Global Benefits Group Commercial |
$268.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.46
|
| Rate for Payer: Multiplan Commercial |
$358.21
|
| Rate for Payer: Networks By Design Commercial |
$223.88
|
| Rate for Payer: Prime Health Services Commercial |
$380.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.04
|
| Rate for Payer: United Healthcare All Other HMO |
$163.57
|
| Rate for Payer: United Healthcare HMO Rider |
$160.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.64
|
|
|
HC CATH MAHURKAR 11.5FR 19.5 CM
|
Facility
|
IP
|
$479.14
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.83 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$95.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$215.61
|
| Rate for Payer: Cash Price |
$215.61
|
| Rate for Payer: Cigna of CA HMO |
$335.40
|
| Rate for Payer: Cigna of CA PPO |
$335.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.66
|
| Rate for Payer: EPIC Health Plan Senior |
$191.66
|
| Rate for Payer: Galaxy Health WC |
$407.27
|
| Rate for Payer: Global Benefits Group Commercial |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.99
|
| Rate for Payer: Multiplan Commercial |
$383.31
|
| Rate for Payer: Networks By Design Commercial |
$239.57
|
| Rate for Payer: Prime Health Services Commercial |
$407.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.82
|
| Rate for Payer: United Healthcare All Other HMO |
$175.03
|
| Rate for Payer: United Healthcare HMO Rider |
$171.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.92
|
|
|
HC CATH MAHURKAR 11.5FR 19.5 CM
|
Facility
|
OP
|
$479.14
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.83 |
| Max. Negotiated Rate |
$407.27 |
| Rate for Payer: Adventist Health Commercial |
$95.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$407.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.52
|
| Rate for Payer: Blue Shield of California Commercial |
$353.61
|
| Rate for Payer: Blue Shield of California EPN |
$232.86
|
| Rate for Payer: Cash Price |
$215.61
|
| Rate for Payer: Cigna of CA HMO |
$335.40
|
| Rate for Payer: Cigna of CA PPO |
$335.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$407.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.66
|
| Rate for Payer: EPIC Health Plan Senior |
$191.66
|
| Rate for Payer: Galaxy Health WC |
$407.27
|
| Rate for Payer: Global Benefits Group Commercial |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.40
|
| Rate for Payer: Multiplan Commercial |
$383.31
|
| Rate for Payer: Networks By Design Commercial |
$239.57
|
| Rate for Payer: Prime Health Services Commercial |
$407.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.82
|
| Rate for Payer: United Healthcare All Other HMO |
$175.03
|
| Rate for Payer: United Healthcare HMO Rider |
$171.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$407.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.27
|
| Rate for Payer: Vantage Medical Group Senior |
$407.27
|
|
|
HC CATH MAHURKAR 12FR X 13CM
|
Facility
|
OP
|
$576.93
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.39 |
| Max. Negotiated Rate |
$490.39 |
| Rate for Payer: Adventist Health Commercial |
$115.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.16
|
| Rate for Payer: Blue Shield of California Commercial |
$425.77
|
| Rate for Payer: Blue Shield of California EPN |
$280.39
|
| Rate for Payer: Cash Price |
$259.62
|
| Rate for Payer: Cigna of CA HMO |
$403.85
|
| Rate for Payer: Cigna of CA PPO |
$403.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.77
|
| Rate for Payer: EPIC Health Plan Senior |
$230.77
|
| Rate for Payer: Galaxy Health WC |
$490.39
|
| Rate for Payer: Global Benefits Group Commercial |
$346.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$357.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.85
|
| Rate for Payer: Multiplan Commercial |
$461.54
|
| Rate for Payer: Networks By Design Commercial |
$288.46
|
| Rate for Payer: Prime Health Services Commercial |
$490.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.52
|
| Rate for Payer: United Healthcare All Other HMO |
$210.75
|
| Rate for Payer: United Healthcare HMO Rider |
$206.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.39
|
| Rate for Payer: Vantage Medical Group Senior |
$490.39
|
|
|
HC CATH MAHURKAR 12FR X 13CM
|
Facility
|
IP
|
$576.93
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.39 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$115.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$259.62
|
| Rate for Payer: Cash Price |
$259.62
|
| Rate for Payer: Cigna of CA HMO |
$403.85
|
| Rate for Payer: Cigna of CA PPO |
$403.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.77
|
| Rate for Payer: EPIC Health Plan Senior |
$230.77
|
| Rate for Payer: Galaxy Health WC |
$490.39
|
| Rate for Payer: Global Benefits Group Commercial |
$346.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$357.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.46
|
| Rate for Payer: Multiplan Commercial |
$461.54
|
| Rate for Payer: Networks By Design Commercial |
$288.46
|
| Rate for Payer: Prime Health Services Commercial |
$490.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.52
|
| Rate for Payer: United Healthcare All Other HMO |
$210.75
|
| Rate for Payer: United Healthcare HMO Rider |
$206.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.94
|
|
|
HC CATH MAHURKAR TL ST 12FR 16CM
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605323
|
|
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 |
$261.00
|
| 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 MAHURKAR TL ST 12FR 16CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605323
|
|
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 |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| 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 MAHURKAR TL ST 12FR 20CM
|
Facility
|
IP
|
$584.57
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.91 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$116.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$263.06
|
| Rate for Payer: Cash Price |
$263.06
|
| Rate for Payer: Cigna of CA HMO |
$409.20
|
| Rate for Payer: Cigna of CA PPO |
$409.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.83
|
| Rate for Payer: EPIC Health Plan Senior |
$233.83
|
| Rate for Payer: Galaxy Health WC |
$496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$350.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.30
|
| Rate for Payer: Multiplan Commercial |
$467.66
|
| Rate for Payer: Networks By Design Commercial |
$292.29
|
| Rate for Payer: Prime Health Services Commercial |
$496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.39
|
| Rate for Payer: United Healthcare All Other HMO |
$213.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.45
|
|
|
HC CATH MAHURKAR TL ST 12FR 20CM
|
Facility
|
OP
|
$584.57
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.91 |
| Max. Negotiated Rate |
$496.88 |
| Rate for Payer: Adventist Health Commercial |
$116.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$438.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.58
|
| Rate for Payer: Blue Shield of California Commercial |
$431.41
|
| Rate for Payer: Blue Shield of California EPN |
$284.10
|
| Rate for Payer: Cash Price |
$263.06
|
| Rate for Payer: Cigna of CA HMO |
$409.20
|
| Rate for Payer: Cigna of CA PPO |
$409.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.83
|
| Rate for Payer: EPIC Health Plan Senior |
$233.83
|
| Rate for Payer: Galaxy Health WC |
$496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$350.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$409.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$409.20
|
| Rate for Payer: Multiplan Commercial |
$467.66
|
| Rate for Payer: Networks By Design Commercial |
$292.29
|
| Rate for Payer: Prime Health Services Commercial |
$496.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$350.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.39
|
| Rate for Payer: United Healthcare All Other HMO |
$213.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$496.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.88
|
| Rate for Payer: Vantage Medical Group Senior |
$496.88
|
|
|
HC CATH MALE EXT .21MM SPORT
|
Facility
|
IP
|
$8.45
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Senior |
$3.38
|
| Rate for Payer: Galaxy Health WC |
$7.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.18
|
|
|
HC CATH MALE EXT .21MM SPORT
|
Facility
|
OP
|
$8.45
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.19
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cigna of CA HMO |
$5.41
|
| Rate for Payer: Cigna of CA PPO |
$6.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Senior |
$3.38
|
| Rate for Payer: Galaxy Health WC |
$7.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.92
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Other HMO |
$4.22
|
| Rate for Payer: United Healthcare HMO Rider |
$4.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Vantage Medical Group Senior |
$7.18
|
|
|
HC CATH MALE EXT .25MM SPORT
|
Facility
|
IP
|
$8.45
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Senior |
$3.38
|
| Rate for Payer: Galaxy Health WC |
$7.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.18
|
|
