|
HC CATH BLLN CORDIS PWRFLEX EXTRM
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$544.77
|
| Rate for Payer: Blue Shield of California Commercial |
$456.30
|
| Rate for Payer: Blue Shield of California Commercial |
$692.10
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO |
$630.00
|
| Rate for Payer: Cigna of CA PPO |
$630.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$630.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$571.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$531.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$630.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$630.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$450.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.77
|
| Rate for Payer: United Healthcare All Other HMO |
$328.77
|
| Rate for Payer: United Healthcare HMO Rider |
$321.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$294.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC CATH BLLN JUPITER PTA
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,416.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,186.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,799.46
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,989.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,638.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,485.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$849.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,380.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,638.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,404.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$878.20
|
| Rate for Payer: United Healthcare All Other HMO |
$854.80
|
| Rate for Payer: United Healthcare HMO Rider |
$836.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$766.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC CATH BLLN JUPITER PTA
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,638.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,485.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,380.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$878.20
|
| Rate for Payer: United Healthcare All Other HMO |
$854.80
|
| Rate for Payer: United Healthcare HMO Rider |
$836.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$766.35
|
|
|
HC CATH BLLN URETHRAL COOK
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901692022
|
|
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 |
$351.07
|
| Rate for Payer: Blue Shield of California Commercial |
$294.06
|
| Rate for Payer: Blue Shield of California Commercial |
$446.02
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| 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 BLLN URETHRAL COOK
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901692022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| 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 BRAUN MULTI TRACK 5FR
|
Facility
|
OP
|
$250.67
|
|
| Hospital Charge Code |
906812268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$213.07 |
| Rate for Payer: Adventist Health Commercial |
$50.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.85
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$160.43
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$213.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.27
|
| Rate for Payer: EPIC Health Plan Senior |
$100.27
|
| Rate for Payer: Galaxy Health WC |
$213.07
|
| Rate for Payer: Global Benefits Group Commercial |
$150.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.47
|
| Rate for Payer: Multiplan Commercial |
$200.54
|
| Rate for Payer: Networks By Design Commercial |
$162.94
|
| Rate for Payer: Prime Health Services Commercial |
$213.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.33
|
| Rate for Payer: United Healthcare All Other HMO |
$125.33
|
| Rate for Payer: United Healthcare HMO Rider |
$125.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.07
|
| Rate for Payer: Vantage Medical Group Senior |
$213.07
|
|
|
HC CATH BRAUN MULTI TRACK 5FR
|
Facility
|
IP
|
$250.67
|
|
| Hospital Charge Code |
906812268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$213.07 |
| Rate for Payer: Adventist Health Commercial |
$50.13
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.27
|
| Rate for Payer: EPIC Health Plan Senior |
$100.27
|
| Rate for Payer: Galaxy Health WC |
$213.07
|
| Rate for Payer: Global Benefits Group Commercial |
$150.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.16
|
| Rate for Payer: Multiplan Commercial |
$200.54
|
| Rate for Payer: Networks By Design Commercial |
$162.94
|
| Rate for Payer: Prime Health Services Commercial |
$213.07
|
|
|
HC CATH BRAUN MULTI TRACK 6FR
|
Facility
|
IP
|
$303.80
|
|
| Hospital Charge Code |
906812437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$258.23 |
| Rate for Payer: Adventist Health Commercial |
$60.76
|
| Rate for Payer: Cash Price |
$136.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.52
|
| Rate for Payer: EPIC Health Plan Senior |
$121.52
|
| Rate for Payer: Galaxy Health WC |
$258.23
|
| Rate for Payer: Global Benefits Group Commercial |
$182.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.91
|
| Rate for Payer: Multiplan Commercial |
$243.04
|
| Rate for Payer: Networks By Design Commercial |
$197.47
|
| Rate for Payer: Prime Health Services Commercial |
$258.23
|
|
|
HC CATH BRAUN MULTI TRACK 6FR
|
Facility
|
OP
|
$303.80
|
|
| Hospital Charge Code |
906812437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$258.23 |
| Rate for Payer: Adventist Health Commercial |
$60.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.95
|
| Rate for Payer: Cash Price |
$136.71
|
| Rate for Payer: Cigna of CA HMO |
$194.43
|
| Rate for Payer: Cigna of CA PPO |
$224.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.52
|
| Rate for Payer: EPIC Health Plan Senior |
$121.52
|
| Rate for Payer: Galaxy Health WC |
$258.23
|
| Rate for Payer: Global Benefits Group Commercial |
$182.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.66
|
| Rate for Payer: Multiplan Commercial |
$243.04
|
| Rate for Payer: Networks By Design Commercial |
$197.47
|
| Rate for Payer: Prime Health Services Commercial |
$258.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.90
|
| Rate for Payer: United Healthcare All Other HMO |
$151.90
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$258.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.23
|
| Rate for Payer: Vantage Medical Group Senior |
$258.23
|
|
|
HC CATH BROVIAC 4.2FR 90CM PEDS
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901603657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
|
|
HC CATH BROVIAC 4.2FR 90CM PEDS
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901603657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,534.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,285.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,949.41
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC CATH BROVIAC 4.2FR WH
|
Facility
|
IP
|
$2,382.90
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.58 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$476.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,072.30
|
| Rate for Payer: Cash Price |
$1,072.30
|
| Rate for Payer: Cigna of CA HMO |
$1,668.03
|
| Rate for Payer: Cigna of CA PPO |
$1,668.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,668.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.16
|
| Rate for Payer: EPIC Health Plan Senior |
$953.16
|
| Rate for Payer: Galaxy Health WC |
$2,025.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,513.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,405.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.90
|
| Rate for Payer: Multiplan Commercial |
$1,906.32
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$894.30
|
| Rate for Payer: United Healthcare All Other HMO |
$870.47
|
| Rate for Payer: United Healthcare HMO Rider |
$851.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$780.40
|
|
|
HC CATH BROVIAC 4.2FR WH
|
Facility
|
OP
|
$2,382.90
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.58 |
| Max. Negotiated Rate |
$2,025.46 |
| Rate for Payer: Adventist Health Commercial |
$476.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,025.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,787.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,442.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,208.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,832.45
|
| Rate for Payer: Cash Price |
$1,072.30
|
| Rate for Payer: Cigna of CA HMO |
$1,668.03
|
| Rate for Payer: Cigna of CA PPO |
$1,668.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,025.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,025.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,025.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,668.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.16
|
| Rate for Payer: EPIC Health Plan Senior |
$953.16
|
| Rate for Payer: Galaxy Health WC |
$2,025.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,513.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$864.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,405.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,668.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,668.03
|
| Rate for Payer: Multiplan Commercial |
$1,906.32
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,429.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$894.30
|
| Rate for Payer: United Healthcare All Other HMO |
$870.47
|
| Rate for Payer: United Healthcare HMO Rider |
$851.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$780.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,025.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,025.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.46
|
|
|
HC CATH B/S RENEGADE MICRO
|
Facility
|
OP
|
$2,106.34
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.43 |
| Max. Negotiated Rate |
$1,790.39 |
| Rate for Payer: Adventist Health Commercial |
$421.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,790.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,158.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,579.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,351.64
|
| Rate for Payer: Cash Price |
$947.85
|
| Rate for Payer: Cash Price |
$947.85
|
| Rate for Payer: Cigna of CA HMO |
$1,348.06
|
| Rate for Payer: Cigna of CA PPO |
$1,558.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,790.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,790.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,790.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,474.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$842.54
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$1,790.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,263.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,337.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$764.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,242.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,474.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,474.44
|
| Rate for Payer: Multiplan Commercial |
$1,685.07
|
| Rate for Payer: Networks By Design Commercial |
$1,369.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,790.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,263.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,263.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,053.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1,053.17
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,790.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,790.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,790.39
|
|
|
HC CATH B/S RENEGADE MICRO
|
Facility
|
IP
|
$2,106.34
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.27 |
| Max. Negotiated Rate |
$1,790.39 |
| Rate for Payer: Adventist Health Commercial |
$421.27
|
| Rate for Payer: Cash Price |
$947.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,474.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$842.54
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$1,790.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,263.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,337.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,242.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.52
|
| Rate for Payer: Multiplan Commercial |
$1,685.07
|
| Rate for Payer: Networks By Design Commercial |
$1,369.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,790.39
|
|
|
HC CATH CATALYST THROM
|
Facility
|
OP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$4,781.25 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,218.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,404.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2,851.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4,325.62
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,781.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,781.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,571.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,041.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,318.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,937.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,937.50
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,375.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,781.25
|
|
|
HC CATH CATALYST THROM
|
Facility
|
IP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,571.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,318.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
|
|
HC CATH CEREBROFLO EVD KIT 10FR
|
Facility
|
OP
|
$3,397.68
|
|
| Hospital Charge Code |
901698291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$679.54 |
| Max. Negotiated Rate |
$2,888.03 |
| Rate for Payer: Adventist Health Commercial |
$679.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,228.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,888.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,868.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,548.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,180.29
|
| Rate for Payer: Cash Price |
$1,528.96
|
| Rate for Payer: Cigna of CA HMO |
$2,174.52
|
| Rate for Payer: Cigna of CA PPO |
$2,514.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,888.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,888.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,888.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,378.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,359.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1,359.07
|
| Rate for Payer: Galaxy Health WC |
$2,888.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2,038.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,157.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,233.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,004.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,378.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,378.38
|
| Rate for Payer: Multiplan Commercial |
$2,718.14
|
| Rate for Payer: Networks By Design Commercial |
$2,208.49
|
| Rate for Payer: Prime Health Services Commercial |
$2,888.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,038.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,038.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,698.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,698.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,698.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,698.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,888.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,888.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2,888.03
|
|
|
HC CATH CEREBROFLO EVD KIT 10FR
|
Facility
|
IP
|
$3,397.68
|
|
| Hospital Charge Code |
901698291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$679.54 |
| Max. Negotiated Rate |
$2,888.03 |
| Rate for Payer: Adventist Health Commercial |
$679.54
|
| Rate for Payer: Cash Price |
$1,528.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,378.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,359.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1,359.07
|
| Rate for Payer: Galaxy Health WC |
$2,888.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2,038.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,157.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,004.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.44
|
| Rate for Payer: Multiplan Commercial |
$2,718.14
|
| Rate for Payer: Networks By Design Commercial |
$2,208.49
|
| Rate for Payer: Prime Health Services Commercial |
$2,888.03
|
|
|
HC CATH CHEST 9.6FR INFANT
|
Facility
|
OP
|
$165.48
|
|
| Hospital Charge Code |
901602295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$140.66 |
| Rate for Payer: Adventist Health Commercial |
$33.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$140.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.19
|
| Rate for Payer: Cash Price |
$74.47
|
| Rate for Payer: Cigna of CA HMO |
$105.91
|
| Rate for Payer: Cigna of CA PPO |
$122.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.19
|
| Rate for Payer: EPIC Health Plan Senior |
$66.19
|
| Rate for Payer: Galaxy Health WC |
$140.66
|
| Rate for Payer: Global Benefits Group Commercial |
$99.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$105.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$115.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$115.84
|
| Rate for Payer: Multiplan Commercial |
$132.38
|
| Rate for Payer: Networks By Design Commercial |
$107.56
|
| Rate for Payer: Prime Health Services Commercial |
$140.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.74
|
| Rate for Payer: United Healthcare All Other HMO |
$82.74
|
| Rate for Payer: United Healthcare HMO Rider |
$82.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$140.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.66
|
| Rate for Payer: Vantage Medical Group Senior |
$140.66
|
|
|
HC CATH CHEST 9.6FR INFANT
|
Facility
|
IP
|
$165.48
|
|
| Hospital Charge Code |
901602295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$140.66 |
| Rate for Payer: Adventist Health Commercial |
$33.10
|
| Rate for Payer: Cash Price |
$74.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.19
|
| Rate for Payer: EPIC Health Plan Senior |
$66.19
|
| Rate for Payer: Galaxy Health WC |
$140.66
|
| Rate for Payer: Global Benefits Group Commercial |
$99.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$105.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.72
|
| Rate for Payer: Multiplan Commercial |
$132.38
|
| Rate for Payer: Networks By Design Commercial |
$107.56
|
| Rate for Payer: Prime Health Services Commercial |
$140.66
|
|
|
HC CATH CLEANER THROM
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$2,922.30 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,890.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,578.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,081.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,743.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,643.82
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cigna of CA HMO |
$2,406.60
|
| Rate for Payer: Cigna of CA PPO |
$2,406.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,922.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,922.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,406.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,375.20
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,183.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,247.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,028.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,406.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,406.60
|
| Rate for Payer: Multiplan Commercial |
$2,750.40
|
| Rate for Payer: Networks By Design Commercial |
$1,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,062.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,290.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,228.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,125.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,922.30
|
|
|
HC CATH CLEANER THROM
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cigna of CA HMO |
$2,406.60
|
| Rate for Payer: Cigna of CA PPO |
$2,406.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,406.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,375.20
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,183.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,028.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.12
|
| Rate for Payer: Multiplan Commercial |
$2,750.40
|
| Rate for Payer: Networks By Design Commercial |
$1,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,290.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,228.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,125.94
|
|
|
HC CATH CLOSED SUCTION 10FR
|
Facility
|
IP
|
$104.96
|
|
| Hospital Charge Code |
901605543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$89.22 |
| Rate for Payer: Adventist Health Commercial |
$20.99
|
| Rate for Payer: Cash Price |
$47.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.98
|
| Rate for Payer: EPIC Health Plan Senior |
$41.98
|
| Rate for Payer: Galaxy Health WC |
$89.22
|
| Rate for Payer: Global Benefits Group Commercial |
$62.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.19
|
| Rate for Payer: Multiplan Commercial |
$83.97
|
| Rate for Payer: Networks By Design Commercial |
$68.22
|
| Rate for Payer: Prime Health Services Commercial |
$89.22
|
|
|
HC CATH CLOSED SUCTION 10FR
|
Facility
|
OP
|
$104.96
|
|
| Hospital Charge Code |
901605543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$89.22 |
| Rate for Payer: Adventist Health Commercial |
$20.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.35
|
| Rate for Payer: Cash Price |
$47.23
|
| Rate for Payer: Cigna of CA HMO |
$67.17
|
| Rate for Payer: Cigna of CA PPO |
$77.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.98
|
| Rate for Payer: EPIC Health Plan Senior |
$41.98
|
| Rate for Payer: Galaxy Health WC |
$89.22
|
| Rate for Payer: Global Benefits Group Commercial |
$62.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.47
|
| Rate for Payer: Multiplan Commercial |
$83.97
|
| Rate for Payer: Networks By Design Commercial |
$68.22
|
| Rate for Payer: Prime Health Services Commercial |
$89.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.48
|
| Rate for Payer: United Healthcare All Other HMO |
$52.48
|
| Rate for Payer: United Healthcare HMO Rider |
$52.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.22
|
| Rate for Payer: Vantage Medical Group Senior |
$89.22
|
|
