|
HC CATHETER DOUBLE LUMEN (COOK)
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909001063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna of CA HMO |
$108.50
|
| Rate for Payer: Cigna of CA PPO |
$108.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.00
|
| Rate for Payer: EPIC Health Plan Senior |
$62.00
|
| Rate for Payer: Galaxy Health WC |
$131.75
|
| Rate for Payer: Global Benefits Group Commercial |
$93.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$124.00
|
| Rate for Payer: Networks By Design Commercial |
$77.50
|
| Rate for Payer: Prime Health Services Commercial |
$131.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.17
|
| Rate for Payer: United Healthcare All Other HMO |
$56.62
|
| Rate for Payer: United Healthcare HMO Rider |
$55.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.76
|
|
|
HC CATHETER/GUIDING
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
|
|
HC CATHETER/GUIDING
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$213.43 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.51
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO |
$115.20
|
| Rate for Payer: Cigna of CA PPO |
$133.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.00
|
| Rate for Payer: United Healthcare All Other HMO |
$90.00
|
| Rate for Payer: United Healthcare HMO Rider |
$90.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC CATHETERIZATION-SPECIMEN ONLY
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
907201169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$141.95 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$116.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.80
|
| Rate for Payer: EPIC Health Plan Senior |
$66.80
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
|
|
HC CATHETERIZATION-SPECIMEN ONLY
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
907201169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$141.95 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.16
|
| Rate for Payer: Blue Shield of California Commercial |
$76.99
|
| Rate for Payer: Blue Shield of California Commercial |
$116.40
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$116.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
|
|
HC CATHETER MEDTRONIC ASPIRATION
|
Facility
|
IP
|
$2,710.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.10 |
| Max. Negotiated Rate |
$2,303.93 |
| Rate for Payer: Adventist Health Commercial |
$542.10
|
| Rate for Payer: Cash Price |
$1,219.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,897.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,084.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,084.20
|
| Rate for Payer: Galaxy Health WC |
$2,303.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1,626.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,721.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,599.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.52
|
| Rate for Payer: Multiplan Commercial |
$2,168.40
|
| Rate for Payer: Networks By Design Commercial |
$1,761.83
|
| Rate for Payer: Prime Health Services Commercial |
$2,303.93
|
|
|
HC CATHETER MEDTRONIC ASPIRATION
|
Facility
|
OP
|
$2,710.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.10 |
| Max. Negotiated Rate |
$6,478.34 |
| Rate for Payer: Adventist Health Commercial |
$542.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,478.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,303.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,490.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,032.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,739.33
|
| Rate for Payer: Cash Price |
$1,219.73
|
| Rate for Payer: Cash Price |
$1,219.73
|
| Rate for Payer: Cigna of CA HMO |
$1,734.72
|
| Rate for Payer: Cigna of CA PPO |
$2,005.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,303.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,303.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,303.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,897.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,084.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,084.20
|
| Rate for Payer: Galaxy Health WC |
$2,303.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1,626.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,721.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$983.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,599.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,897.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,897.35
|
| Rate for Payer: Multiplan Commercial |
$2,168.40
|
| Rate for Payer: Networks By Design Commercial |
$1,761.83
|
| Rate for Payer: Prime Health Services Commercial |
$2,303.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,626.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,626.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,355.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,355.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,355.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,355.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,303.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,303.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2,303.93
|
|
|
HC CATHETER, MULTI MARKER
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$3,036.30 |
| Rate for Payer: Adventist Health Commercial |
$289.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,036.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,231.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$796.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,086.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$929.82
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cigna of CA HMO |
$927.36
|
| Rate for Payer: Cigna of CA PPO |
$1,072.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,231.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,231.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,231.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,014.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.60
|
| Rate for Payer: EPIC Health Plan Senior |
$579.60
|
| Rate for Payer: Galaxy Health WC |
$1,231.65
|
| Rate for Payer: Global Benefits Group Commercial |
$869.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$920.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$525.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$854.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,014.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,014.30
|
| Rate for Payer: Multiplan Commercial |
$1,159.20
|
| Rate for Payer: Networks By Design Commercial |
$941.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,231.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$869.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$869.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$724.50
|
| Rate for Payer: United Healthcare All Other HMO |
$724.50
|
| Rate for Payer: United Healthcare HMO Rider |
$724.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,231.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,231.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,231.65
|
|
|
HC CATHETER, MULTI MARKER
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$1,231.65 |
| Rate for Payer: Adventist Health Commercial |
$289.80
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,014.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.60
|
| Rate for Payer: EPIC Health Plan Senior |
$579.60
|
| Rate for Payer: Galaxy Health WC |
$1,231.65
|
| Rate for Payer: Global Benefits Group Commercial |
$869.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$920.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$854.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.76
|
| Rate for Payer: Multiplan Commercial |
$1,159.20
|
| Rate for Payer: Networks By Design Commercial |
$941.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,231.65
|
|
|
HC CATHETER PIONEER
|
Facility
|
IP
|
$7,987.50
|
|
|
Service Code
|
CPT C1753
|
| Hospital Charge Code |
909020110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,597.50 |
| Max. Negotiated Rate |
$6,789.38 |
| Rate for Payer: Adventist Health Commercial |
$1,597.50
|
| Rate for Payer: Cash Price |
$3,594.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,591.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,195.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,195.00
|
| Rate for Payer: Galaxy Health WC |
$6,789.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4,792.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,072.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,712.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,917.00
|
| Rate for Payer: Multiplan Commercial |
$6,390.00
|
| Rate for Payer: Networks By Design Commercial |
$5,191.88
|
| Rate for Payer: Prime Health Services Commercial |
$6,789.38
|
|
|
HC CATHETER PIONEER
|
Facility
|
OP
|
$7,987.50
|
|
|
Service Code
|
CPT C1753
|
| Hospital Charge Code |
909020110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,597.50 |
| Max. Negotiated Rate |
$6,789.38 |
| Rate for Payer: Adventist Health Commercial |
$1,597.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,042.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,789.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,393.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,990.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,125.58
|
| Rate for Payer: Cash Price |
$3,594.38
|
| Rate for Payer: Cash Price |
$3,594.38
|
| Rate for Payer: Cigna of CA HMO |
$5,112.00
|
| Rate for Payer: Cigna of CA PPO |
$5,910.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,789.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,789.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,789.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,591.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,195.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,195.00
|
| Rate for Payer: Galaxy Health WC |
$6,789.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4,792.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,072.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,899.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,712.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,917.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,591.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,591.25
|
| Rate for Payer: Multiplan Commercial |
$6,390.00
|
| Rate for Payer: Networks By Design Commercial |
$5,191.88
|
| Rate for Payer: Prime Health Services Commercial |
$6,789.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,792.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,792.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,993.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3,993.75
|
| Rate for Payer: United Healthcare HMO Rider |
$3,993.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,993.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,789.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,789.38
|
| Rate for Payer: Vantage Medical Group Senior |
$6,789.38
|
|
|
HC CATH FEMORAL ARTRY 18FR 4-1/4
|
Facility
|
OP
|
$101.61
|
|
| Hospital Charge Code |
901602851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$86.37 |
| Rate for Payer: Adventist Health Commercial |
$20.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.20
|
| Rate for Payer: Cash Price |
$45.72
|
| Rate for Payer: Cigna of CA HMO |
$65.03
|
| Rate for Payer: Cigna of CA PPO |
$75.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.64
|
| Rate for Payer: EPIC Health Plan Senior |
$40.64
|
| Rate for Payer: Galaxy Health WC |
$86.37
|
| Rate for Payer: Global Benefits Group Commercial |
$60.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.13
|
| Rate for Payer: Multiplan Commercial |
$81.29
|
| Rate for Payer: Networks By Design Commercial |
$66.05
|
| Rate for Payer: Prime Health Services Commercial |
$86.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.80
|
| Rate for Payer: United Healthcare All Other HMO |
$50.80
|
| Rate for Payer: United Healthcare HMO Rider |
$50.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.37
|
| Rate for Payer: Vantage Medical Group Senior |
$86.37
|
|
|
HC CATH FEMORAL ARTRY 18FR 4-1/4
|
Facility
|
IP
|
$101.61
|
|
| Hospital Charge Code |
901602851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$86.37 |
| Rate for Payer: Multiplan Commercial |
$81.29
|
| Rate for Payer: Networks By Design Commercial |
$66.05
|
| Rate for Payer: Adventist Health Commercial |
$20.32
|
| Rate for Payer: Cash Price |
$45.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.64
|
| Rate for Payer: EPIC Health Plan Senior |
$40.64
|
| Rate for Payer: Galaxy Health WC |
$86.37
|
| Rate for Payer: Global Benefits Group Commercial |
$60.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.39
|
| Rate for Payer: Prime Health Services Commercial |
$86.37
|
|
|
HC CATH FOGARTY 10FR
|
Facility
|
IP
|
$685.40
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
901601481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.08 |
| Max. Negotiated Rate |
$582.59 |
| Rate for Payer: Adventist Health Commercial |
$137.08
|
| Rate for Payer: Cash Price |
$308.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$479.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.16
|
| Rate for Payer: EPIC Health Plan Senior |
$274.16
|
| Rate for Payer: Galaxy Health WC |
$582.59
|
| Rate for Payer: Global Benefits Group Commercial |
$411.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$435.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$404.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$548.32
|
| Rate for Payer: Networks By Design Commercial |
$445.51
|
| Rate for Payer: Prime Health Services Commercial |
$582.59
|
|
|
HC CATH FOGARTY 10FR
|
Facility
|
OP
|
$685.40
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
901601481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.08 |
| Max. Negotiated Rate |
$6,478.34 |
| Rate for Payer: Adventist Health Commercial |
$137.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,478.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$582.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$439.82
|
| Rate for Payer: Cash Price |
$308.43
|
| Rate for Payer: Cash Price |
$308.43
|
| Rate for Payer: Cigna of CA HMO |
$438.66
|
| Rate for Payer: Cigna of CA PPO |
$507.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$582.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$582.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$582.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$479.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.16
|
| Rate for Payer: EPIC Health Plan Senior |
$274.16
|
| Rate for Payer: Galaxy Health WC |
$582.59
|
| Rate for Payer: Global Benefits Group Commercial |
$411.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$435.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$404.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$479.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$479.78
|
| Rate for Payer: Multiplan Commercial |
$548.32
|
| Rate for Payer: Networks By Design Commercial |
$445.51
|
| Rate for Payer: Prime Health Services Commercial |
$582.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$342.70
|
| Rate for Payer: United Healthcare All Other HMO |
$342.70
|
| Rate for Payer: United Healthcare HMO Rider |
$342.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$342.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$582.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$582.59
|
| Rate for Payer: Vantage Medical Group Senior |
$582.59
|
|
|
HC CATH FOGARTY 3FR APPLD MED
|
Facility
|
IP
|
$616.40
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
901601480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.28 |
| Max. Negotiated Rate |
$523.94 |
| Rate for Payer: Adventist Health Commercial |
$123.28
|
| Rate for Payer: Cash Price |
$277.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$431.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.56
|
| Rate for Payer: EPIC Health Plan Senior |
$246.56
|
| Rate for Payer: Galaxy Health WC |
$523.94
|
| Rate for Payer: Global Benefits Group Commercial |
$369.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$391.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$363.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.94
|
| Rate for Payer: Multiplan Commercial |
$493.12
|
| Rate for Payer: Networks By Design Commercial |
$400.66
|
| Rate for Payer: Prime Health Services Commercial |
$523.94
|
|
|
HC CATH FOGARTY 3FR APPLD MED
|
Facility
|
OP
|
$616.40
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
901601480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.28 |
| Max. Negotiated Rate |
$6,478.34 |
| Rate for Payer: Adventist Health Commercial |
$123.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,478.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$523.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.54
|
| Rate for Payer: Cash Price |
$277.38
|
| Rate for Payer: Cash Price |
$277.38
|
| Rate for Payer: Cigna of CA HMO |
$394.50
|
| Rate for Payer: Cigna of CA PPO |
$456.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$523.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$523.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$523.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$431.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.56
|
| Rate for Payer: EPIC Health Plan Senior |
$246.56
|
| Rate for Payer: Galaxy Health WC |
$523.94
|
| Rate for Payer: Global Benefits Group Commercial |
$369.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$391.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$363.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$431.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$431.48
|
| Rate for Payer: Multiplan Commercial |
$493.12
|
| Rate for Payer: Networks By Design Commercial |
$400.66
|
| Rate for Payer: Prime Health Services Commercial |
$523.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$369.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$369.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.20
|
| Rate for Payer: United Healthcare All Other HMO |
$308.20
|
| Rate for Payer: United Healthcare HMO Rider |
$308.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$308.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$523.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$523.94
|
| Rate for Payer: Vantage Medical Group Senior |
$523.94
|
|
|
HC CATH FOLEY 10FR UR METER TRAY
|
Facility
|
OP
|
$287.21
|
|
| Hospital Charge Code |
901698923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.44 |
| Max. Negotiated Rate |
$244.13 |
| Rate for Payer: Adventist Health Commercial |
$57.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.30
|
| Rate for Payer: Cash Price |
$129.24
|
| Rate for Payer: Cigna of CA HMO |
$183.81
|
| Rate for Payer: Cigna of CA PPO |
$212.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$201.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.88
|
| Rate for Payer: EPIC Health Plan Senior |
$114.88
|
| Rate for Payer: Galaxy Health WC |
$244.13
|
| Rate for Payer: Global Benefits Group Commercial |
$172.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.05
|
| Rate for Payer: Multiplan Commercial |
$229.77
|
| Rate for Payer: Networks By Design Commercial |
$186.69
|
| Rate for Payer: Prime Health Services Commercial |
$244.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.60
|
| Rate for Payer: United Healthcare All Other HMO |
$143.60
|
| Rate for Payer: United Healthcare HMO Rider |
$143.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.13
|
| Rate for Payer: Vantage Medical Group Senior |
$244.13
|
|
|
HC CATH FOLEY 10FR UR METER TRAY
|
Facility
|
IP
|
$287.21
|
|
| Hospital Charge Code |
901698923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.44 |
| Max. Negotiated Rate |
$244.13 |
| Rate for Payer: Adventist Health Commercial |
$57.44
|
| Rate for Payer: Cash Price |
$129.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$201.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.88
|
| Rate for Payer: EPIC Health Plan Senior |
$114.88
|
| Rate for Payer: Galaxy Health WC |
$244.13
|
| Rate for Payer: Global Benefits Group Commercial |
$172.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.93
|
| Rate for Payer: Multiplan Commercial |
$229.77
|
| Rate for Payer: Networks By Design Commercial |
$186.69
|
| Rate for Payer: Prime Health Services Commercial |
$244.13
|
|
|
HC CATH FOLEY 14FR COUDE 2WAY
|
Facility
|
IP
|
$136.88
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Adventist Health Commercial |
$27.38
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.75
|
| Rate for Payer: EPIC Health Plan Senior |
$54.75
|
| Rate for Payer: Galaxy Health WC |
$116.35
|
| Rate for Payer: Global Benefits Group Commercial |
$82.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.85
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: Networks By Design Commercial |
$88.97
|
| Rate for Payer: Prime Health Services Commercial |
$116.35
|
|
|
HC CATH FOLEY 14FR COUDE 2WAY
|
Facility
|
IP
|
$27.14
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$23.07 |
| Rate for Payer: Adventist Health Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.86
|
| Rate for Payer: EPIC Health Plan Senior |
$10.86
|
| Rate for Payer: Galaxy Health WC |
$23.07
|
| Rate for Payer: Global Benefits Group Commercial |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$21.71
|
| Rate for Payer: Networks By Design Commercial |
$17.64
|
| Rate for Payer: Prime Health Services Commercial |
$23.07
|
|
|
HC CATH FOLEY 14FR COUDE 2WAY
|
Facility
|
OP
|
$27.14
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$90.52 |
| Rate for Payer: Adventist Health Commercial |
$5.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.42
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna of CA HMO |
$17.37
|
| Rate for Payer: Cigna of CA PPO |
$20.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.86
|
| Rate for Payer: EPIC Health Plan Senior |
$10.86
|
| Rate for Payer: Galaxy Health WC |
$23.07
|
| Rate for Payer: Global Benefits Group Commercial |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$21.71
|
| Rate for Payer: Networks By Design Commercial |
$17.64
|
| Rate for Payer: Prime Health Services Commercial |
$23.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.57
|
| Rate for Payer: United Healthcare All Other HMO |
$13.57
|
| Rate for Payer: United Healthcare HMO Rider |
$13.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.07
|
| Rate for Payer: Vantage Medical Group Senior |
$23.07
|
|
|
HC CATH FOLEY 14FR COUDE 2WAY
|
Facility
|
OP
|
$136.88
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Adventist Health Commercial |
$27.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.84
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$87.60
|
| Rate for Payer: Cigna of CA PPO |
$101.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.75
|
| Rate for Payer: EPIC Health Plan Senior |
$54.75
|
| Rate for Payer: Galaxy Health WC |
$116.35
|
| Rate for Payer: Global Benefits Group Commercial |
$82.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.82
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: Networks By Design Commercial |
$88.97
|
| Rate for Payer: Prime Health Services Commercial |
$116.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.44
|
| Rate for Payer: United Healthcare All Other HMO |
$68.44
|
| Rate for Payer: United Healthcare HMO Rider |
$68.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.35
|
| Rate for Payer: Vantage Medical Group Senior |
$116.35
|
|
|
HC CATH FOLEY 16FR 2WY TEMP SNS
|
Facility
|
IP
|
$103.66
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901698557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$88.11 |
| Rate for Payer: Adventist Health Commercial |
$20.73
|
| Rate for Payer: Cash Price |
$46.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.46
|
| Rate for Payer: EPIC Health Plan Senior |
$41.46
|
| Rate for Payer: Galaxy Health WC |
$88.11
|
| Rate for Payer: Global Benefits Group Commercial |
$62.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$82.93
|
| Rate for Payer: Networks By Design Commercial |
$67.38
|
| Rate for Payer: Prime Health Services Commercial |
$88.11
|
|
|
HC CATH FOLEY 16FR 2WY TEMP SNS
|
Facility
|
OP
|
$103.66
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901698557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$88.11 |
| Rate for Payer: Adventist Health Commercial |
$20.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.52
|
| Rate for Payer: Cash Price |
$46.65
|
| Rate for Payer: Cash Price |
$46.65
|
| Rate for Payer: Cigna of CA HMO |
$66.34
|
| Rate for Payer: Cigna of CA PPO |
$76.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.46
|
| Rate for Payer: EPIC Health Plan Senior |
$41.46
|
| Rate for Payer: Galaxy Health WC |
$88.11
|
| Rate for Payer: Global Benefits Group Commercial |
$62.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.56
|
| Rate for Payer: Multiplan Commercial |
$82.93
|
| Rate for Payer: Networks By Design Commercial |
$67.38
|
| Rate for Payer: Prime Health Services Commercial |
$88.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.83
|
| Rate for Payer: United Healthcare All Other HMO |
$51.83
|
| Rate for Payer: United Healthcare HMO Rider |
$51.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.11
|
| Rate for Payer: Vantage Medical Group Senior |
$88.11
|
|
