|
HC CATH CRICOTHYROTOMY ADULT
|
Facility
|
OP
|
$963.19
|
|
| Hospital Charge Code |
901602640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.64 |
| Max. Negotiated Rate |
$818.71 |
| Rate for Payer: Cigna of CA PPO |
$712.76
|
| Rate for Payer: Adventist Health Commercial |
$192.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$631.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$818.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$618.08
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna of CA HMO |
$616.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$818.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$818.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$818.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.28
|
| Rate for Payer: EPIC Health Plan Senior |
$385.28
|
| Rate for Payer: Galaxy Health WC |
$818.71
|
| Rate for Payer: Global Benefits Group Commercial |
$577.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$611.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$568.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.23
|
| Rate for Payer: Multiplan Commercial |
$770.55
|
| Rate for Payer: Networks By Design Commercial |
$626.07
|
| Rate for Payer: Prime Health Services Commercial |
$818.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$577.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.60
|
| Rate for Payer: United Healthcare All Other HMO |
$481.60
|
| Rate for Payer: United Healthcare HMO Rider |
$481.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$481.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$818.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$818.71
|
| Rate for Payer: Vantage Medical Group Senior |
$818.71
|
|
|
HC CATH CV 7FR 6" TL FULL TRAY
|
Facility
|
IP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$272.48
|
| Rate for Payer: Cash Price |
$272.48
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$357.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.32
|
| Rate for Payer: Multiplan Commercial |
$484.40
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
|
|
HC CATH CV 7FR 6" TL FULL TRAY
|
Facility
|
OP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$514.67 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.51
|
| Rate for Payer: Blue Shield of California Commercial |
$306.99
|
| Rate for Payer: Blue Shield of California Commercial |
$465.63
|
| Rate for Payer: Cash Price |
$272.48
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$357.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.85
|
| Rate for Payer: Multiplan Commercial |
$484.40
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.67
|
| Rate for Payer: Vantage Medical Group Senior |
$514.67
|
|
|
HC CATH CV 7FR 8" TL FULL TRAY
|
Facility
|
IP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$272.48
|
| Rate for Payer: Cash Price |
$272.48
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$357.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.32
|
| Rate for Payer: Multiplan Commercial |
$484.40
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
|
|
HC CATH CV 7FR 8" TL FULL TRAY
|
Facility
|
OP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$514.67 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.51
|
| Rate for Payer: Blue Shield of California Commercial |
$306.99
|
| Rate for Payer: Blue Shield of California Commercial |
$465.63
|
| Rate for Payer: Cash Price |
$272.48
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$357.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.85
|
| Rate for Payer: Multiplan Commercial |
$484.40
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.67
|
| Rate for Payer: Vantage Medical Group Senior |
$514.67
|
|
|
HC CATH CV 8FR 6" DL FULL TRAY
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$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: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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 CV 8FR 6" DL FULL TRAY
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 DIALYSIS 13FR 15CM TRIALYSIS CURVED
|
Facility
|
IP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$156.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$495.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.24
|
| Rate for Payer: Multiplan Commercial |
$624.13
|
| Rate for Payer: Networks By Design Commercial |
$390.08
|
| Rate for Payer: Prime Health Services Commercial |
$663.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.79
|
| Rate for Payer: United Healthcare All Other HMO |
$284.99
|
| Rate for Payer: United Healthcare HMO Rider |
$278.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.50
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED
|
Facility
|
OP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$663.14 |
| Rate for Payer: Adventist Health Commercial |
$156.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$472.23
|
| Rate for Payer: Blue Shield of California Commercial |
$395.54
|
| Rate for Payer: Blue Shield of California Commercial |
$599.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$495.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$460.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$546.11
|
| Rate for Payer: Multiplan Commercial |
$624.13
|
| Rate for Payer: Networks By Design Commercial |
$390.08
|
| Rate for Payer: Prime Health Services Commercial |
$663.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.79
|
| Rate for Payer: United Healthcare All Other HMO |
$284.99
|
| Rate for Payer: United Healthcare HMO Rider |
$278.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.14
|
| Rate for Payer: Vantage Medical Group Senior |
$663.14
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED LEG
|
Facility
|
IP
|
$1,030.12
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.02 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$206.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$463.55
|
| Rate for Payer: Cash Price |
$463.55
|
| Rate for Payer: Cigna of CA HMO |
$721.08
|
| Rate for Payer: Cigna of CA PPO |
$721.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$721.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.05
|
| Rate for Payer: EPIC Health Plan Senior |
$412.05
|
| Rate for Payer: Galaxy Health WC |
$875.60
|
| Rate for Payer: Global Benefits Group Commercial |
$618.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$654.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$607.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.23
|
| Rate for Payer: Multiplan Commercial |
$824.10
|
| Rate for Payer: Networks By Design Commercial |
$515.06
|
| Rate for Payer: Prime Health Services Commercial |
$875.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.60
|
| Rate for Payer: United Healthcare All Other HMO |
$376.30
|
| Rate for Payer: United Healthcare HMO Rider |
$368.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.36
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED LEG
|
Facility
|
OP
|
$1,030.12
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.02 |
| Max. Negotiated Rate |
$875.60 |
| Rate for Payer: Adventist Health Commercial |
$206.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$875.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$772.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$623.53
|
| Rate for Payer: Blue Shield of California Commercial |
$522.27
|
| Rate for Payer: Blue Shield of California Commercial |
$792.16
|
| Rate for Payer: Cash Price |
$463.55
|
| Rate for Payer: Cigna of CA HMO |
$721.08
|
| Rate for Payer: Cigna of CA PPO |
$721.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$875.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$875.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$875.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$721.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.05
|
| Rate for Payer: EPIC Health Plan Senior |
$412.05
|
| Rate for Payer: Galaxy Health WC |
$875.60
|
| Rate for Payer: Global Benefits Group Commercial |
$618.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$654.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$373.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$607.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$721.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$721.08
|
| Rate for Payer: Multiplan Commercial |
$824.10
|
| Rate for Payer: Networks By Design Commercial |
$515.06
|
| Rate for Payer: Prime Health Services Commercial |
$875.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$618.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.60
|
| Rate for Payer: United Healthcare All Other HMO |
$376.30
|
| Rate for Payer: United Healthcare HMO Rider |
$368.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$875.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$875.60
|
| Rate for Payer: Vantage Medical Group Senior |
$875.60
|
|
|
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 |
$591.35
|
| Rate for Payer: Blue Shield of California Commercial |
$495.31
|
| Rate for Payer: Blue Shield of California Commercial |
$751.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$620.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$576.40
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$620.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$576.40
|
| 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
|
IP
|
$976.95
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$620.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$576.40
|
| 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 |
$591.35
|
| Rate for Payer: Blue Shield of California Commercial |
$495.31
|
| Rate for Payer: Blue Shield of California Commercial |
$751.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$620.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$576.40
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,583.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21,393.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,877.10
|
| 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 STNT PLC
|
Facility
|
OP
|
$33,690.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,743.74 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,738.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,583.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,393.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,832.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,085.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$16,845.00
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,924.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,235.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| 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/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,868.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,284.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,112.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,509.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,223.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,809.20
|
| 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 |
$7,311.00
|
| 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 |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,235.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,284.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,626.98
|
| 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 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 |
$1,408.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,179.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,789.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,477.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$844.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,372.73
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$465.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,477.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,372.73
|
| 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 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 |
$567.81
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$619.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$561.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$522.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$619.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$561.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$522.07
|
| 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
|
IP
|
$759.05
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901604190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.81 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$151.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$482.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$447.84
|
| 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 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: EPIC Health Plan Senior |
$303.62
|
| Rate for Payer: Galaxy Health WC |
$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 |
$459.45
|
| Rate for Payer: Blue Shield of California Commercial |
$384.84
|
| Rate for Payer: Blue Shield of California Commercial |
$583.71
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$531.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.62
|
| Rate for Payer: Global Benefits Group Commercial |
$455.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$482.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$275.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$447.84
|
| 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
|
|
