|
HC CATH FUHRMAN 10.2FR DRAIN SET
|
Facility
|
IP
|
$596.90
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.38 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: United Healthcare HMO Rider |
$213.33
|
| Rate for Payer: Adventist Health Commercial |
$119.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$268.60
|
| Rate for Payer: Cash Price |
$268.60
|
| Rate for Payer: Cigna of CA HMO |
$417.83
|
| Rate for Payer: Cigna of CA PPO |
$417.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$417.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.76
|
| Rate for Payer: EPIC Health Plan Senior |
$238.76
|
| Rate for Payer: Galaxy Health WC |
$507.37
|
| Rate for Payer: Global Benefits Group Commercial |
$358.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.26
|
| Rate for Payer: Multiplan Commercial |
$477.52
|
| Rate for Payer: Networks By Design Commercial |
$298.45
|
| Rate for Payer: Prime Health Services Commercial |
$507.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$224.02
|
| Rate for Payer: United Healthcare All Other HMO |
$218.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.48
|
|
|
HC CATH GUIDE CELLO
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909031887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,360.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC CATH GUIDE CELLO
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909031887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC CATH GUIDT RAPIDO ADVANCE
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$584.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$796.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$681.49
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna of CA HMO |
$679.68
|
| Rate for Payer: Cigna of CA PPO |
$785.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$902.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$902.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$902.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$743.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.80
|
| Rate for Payer: EPIC Health Plan Senior |
$424.80
|
| Rate for Payer: Galaxy Health WC |
$902.70
|
| Rate for Payer: Global Benefits Group Commercial |
$637.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$674.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$385.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$626.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$743.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: Networks By Design Commercial |
$690.30
|
| Rate for Payer: Prime Health Services Commercial |
$902.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$531.00
|
| Rate for Payer: United Healthcare All Other HMO |
$531.00
|
| Rate for Payer: United Healthcare HMO Rider |
$531.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$531.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$902.70
|
| Rate for Payer: Vantage Medical Group Senior |
$902.70
|
|
|
HC CATH GUIDT RAPIDO ADVANCE
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$743.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.80
|
| Rate for Payer: EPIC Health Plan Senior |
$424.80
|
| Rate for Payer: Galaxy Health WC |
$902.70
|
| Rate for Payer: Global Benefits Group Commercial |
$637.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$674.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$626.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.88
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: Networks By Design Commercial |
$690.30
|
| Rate for Payer: Prime Health Services Commercial |
$902.70
|
|
|
HC CATH GUIDT RAPIDO CUT-AWAY
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$180.00
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$265.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
|
|
HC CATH GUIDT RAPIDO CUT-AWAY
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$382.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$247.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.76
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna of CA HMO |
$288.00
|
| Rate for Payer: Cigna of CA PPO |
$333.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$382.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$382.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$180.00
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$265.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO |
$225.00
|
| Rate for Payer: United Healthcare HMO Rider |
$225.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$382.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.50
|
| Rate for Payer: Vantage Medical Group Senior |
$382.50
|
|
|
HC CATH GUIDT RAPIDO INNER
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$382.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$247.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.76
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna of CA HMO |
$288.00
|
| Rate for Payer: Cigna of CA PPO |
$333.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$382.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$382.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$180.00
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$265.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO |
$225.00
|
| Rate for Payer: United Healthcare HMO Rider |
$225.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$382.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.50
|
| Rate for Payer: Vantage Medical Group Senior |
$382.50
|
|
|
HC CATH GUIDT RAPIDO INNER
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$180.00
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$265.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
|
|
HC CATH GUIDT SWIFT NINJA
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909001769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,143.75 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,950.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2,471.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3,748.88
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,143.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,095.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,769.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,876.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC CATH GUIDT SWIFT NINJA
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909001769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,095.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,876.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
|
|
HC CATH HDA TRAY 12.5FRX16CM
|
Facility
|
OP
|
$922.39
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$784.03 |
| Rate for Payer: Adventist Health Commercial |
$184.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$691.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$558.32
|
| Rate for Payer: Blue Shield of California Commercial |
$467.65
|
| Rate for Payer: Blue Shield of California Commercial |
$709.32
|
| Rate for Payer: Cash Price |
$415.08
|
| Rate for Payer: Cigna of CA HMO |
$645.67
|
| Rate for Payer: Cigna of CA PPO |
$645.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$784.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$784.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.96
|
| Rate for Payer: EPIC Health Plan Senior |
$368.96
|
| Rate for Payer: Galaxy Health WC |
$784.03
|
| Rate for Payer: Global Benefits Group Commercial |
$553.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$585.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$544.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$645.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.67
|
| Rate for Payer: Multiplan Commercial |
$737.91
|
| Rate for Payer: Networks By Design Commercial |
$461.19
|
| Rate for Payer: Prime Health Services Commercial |
$784.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$346.17
|
| Rate for Payer: United Healthcare All Other HMO |
$336.95
|
| Rate for Payer: United Healthcare HMO Rider |
$329.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$302.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$784.03
|
| Rate for Payer: Vantage Medical Group Senior |
$784.03
|
|
|
HC CATH HDA TRAY 12.5FRX16CM
|
Facility
|
IP
|
$922.39
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$415.08
|
| Rate for Payer: Cigna of CA HMO |
$645.67
|
| Rate for Payer: Cigna of CA PPO |
$645.67
|
| Rate for Payer: Adventist Health Commercial |
$184.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$415.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.96
|
| Rate for Payer: EPIC Health Plan Senior |
$368.96
|
| Rate for Payer: Galaxy Health WC |
$784.03
|
| Rate for Payer: Global Benefits Group Commercial |
$553.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$585.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$544.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.37
|
| Rate for Payer: Multiplan Commercial |
$737.91
|
| Rate for Payer: Networks By Design Commercial |
$461.19
|
| Rate for Payer: Prime Health Services Commercial |
$784.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$346.17
|
| Rate for Payer: United Healthcare All Other HMO |
$336.95
|
| Rate for Payer: United Healthcare HMO Rider |
$329.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$302.08
|
|
|
HC CATH HEMO-CATH 8FR 12CM PEDS
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603577
|
|
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 HEMO-CATH 8FR 12CM PEDS
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC CATH HEMODIALYSIS DBL LUMEN
|
Facility
|
OP
|
$551.12
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.22 |
| Max. Negotiated Rate |
$468.45 |
| Rate for Payer: Adventist Health Commercial |
$110.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.59
|
| Rate for Payer: Blue Shield of California Commercial |
$279.42
|
| Rate for Payer: Blue Shield of California Commercial |
$423.81
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$385.78
|
| Rate for Payer: Cigna of CA PPO |
$385.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.45
|
| Rate for Payer: EPIC Health Plan Senior |
$220.45
|
| Rate for Payer: Galaxy Health WC |
$468.45
|
| Rate for Payer: Global Benefits Group Commercial |
$330.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.78
|
| Rate for Payer: Multiplan Commercial |
$440.90
|
| Rate for Payer: Networks By Design Commercial |
$275.56
|
| Rate for Payer: Prime Health Services Commercial |
$468.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.84
|
| Rate for Payer: United Healthcare All Other HMO |
$201.32
|
| Rate for Payer: United Healthcare HMO Rider |
$196.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.45
|
| Rate for Payer: Vantage Medical Group Senior |
$468.45
|
|
|
HC CATH HEMODIALYSIS DBL LUMEN
|
Facility
|
IP
|
$551.12
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.22 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$110.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$385.78
|
| Rate for Payer: Cigna of CA PPO |
$385.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.45
|
| Rate for Payer: EPIC Health Plan Senior |
$220.45
|
| Rate for Payer: Galaxy Health WC |
$468.45
|
| Rate for Payer: Global Benefits Group Commercial |
$330.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.27
|
| Rate for Payer: Multiplan Commercial |
$440.90
|
| Rate for Payer: Networks By Design Commercial |
$275.56
|
| Rate for Payer: Prime Health Services Commercial |
$468.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.84
|
| Rate for Payer: United Healthcare All Other HMO |
$201.32
|
| Rate for Payer: United Healthcare HMO Rider |
$196.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.49
|
|
|
HC CATH HEMODIALYSIS LONG TERM
|
Facility
|
OP
|
$2,148.20
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.64 |
| Max. Negotiated Rate |
$1,825.97 |
| Rate for Payer: Adventist Health Commercial |
$429.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,825.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,611.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,300.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,089.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,651.97
|
| Rate for Payer: Cash Price |
$966.69
|
| Rate for Payer: Cigna of CA HMO |
$1,503.74
|
| Rate for Payer: Cigna of CA PPO |
$1,503.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,825.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,825.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,825.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,503.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$859.28
|
| Rate for Payer: EPIC Health Plan Senior |
$859.28
|
| Rate for Payer: Galaxy Health WC |
$1,825.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1,288.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,364.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$779.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,267.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,503.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,503.74
|
| Rate for Payer: Multiplan Commercial |
$1,718.56
|
| Rate for Payer: Networks By Design Commercial |
$1,074.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,825.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,288.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,288.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$806.22
|
| Rate for Payer: United Healthcare All Other HMO |
$784.74
|
| Rate for Payer: United Healthcare HMO Rider |
$767.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$703.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,825.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,825.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,825.97
|
|
|
HC CATH HEMODIALYSIS LONG TERM
|
Facility
|
IP
|
$2,148.20
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.64 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$429.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$966.69
|
| Rate for Payer: Cash Price |
$966.69
|
| Rate for Payer: Cigna of CA HMO |
$1,503.74
|
| Rate for Payer: Cigna of CA PPO |
$1,503.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,503.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$859.28
|
| Rate for Payer: EPIC Health Plan Senior |
$859.28
|
| Rate for Payer: Galaxy Health WC |
$1,825.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1,288.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,364.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,267.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.57
|
| Rate for Payer: Multiplan Commercial |
$1,718.56
|
| Rate for Payer: Networks By Design Commercial |
$1,074.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,825.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$806.22
|
| Rate for Payer: United Healthcare All Other HMO |
$784.74
|
| Rate for Payer: United Healthcare HMO Rider |
$767.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$703.54
|
|
|
HC CATH HEMODIALYSIS SHORT-TERM
|
Facility
|
IP
|
$376.24
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$75.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cigna of CA HMO |
$263.37
|
| Rate for Payer: Cigna of CA PPO |
$263.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.50
|
| Rate for Payer: EPIC Health Plan Senior |
$150.50
|
| Rate for Payer: Galaxy Health WC |
$319.80
|
| Rate for Payer: Global Benefits Group Commercial |
$225.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$238.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$221.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.30
|
| Rate for Payer: Multiplan Commercial |
$300.99
|
| Rate for Payer: Networks By Design Commercial |
$188.12
|
| Rate for Payer: Prime Health Services Commercial |
$319.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.20
|
| Rate for Payer: United Healthcare All Other HMO |
$137.44
|
| Rate for Payer: United Healthcare HMO Rider |
$134.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.22
|
|
|
HC CATH HEMODIALYSIS SHORT-TERM
|
Facility
|
OP
|
$376.24
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$319.80 |
| Rate for Payer: Adventist Health Commercial |
$75.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$319.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.74
|
| Rate for Payer: Blue Shield of California Commercial |
$190.75
|
| Rate for Payer: Blue Shield of California Commercial |
$289.33
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cigna of CA HMO |
$263.37
|
| Rate for Payer: Cigna of CA PPO |
$263.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$319.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$319.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$319.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.50
|
| Rate for Payer: EPIC Health Plan Senior |
$150.50
|
| Rate for Payer: Galaxy Health WC |
$319.80
|
| Rate for Payer: Global Benefits Group Commercial |
$225.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$238.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$221.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.37
|
| Rate for Payer: Multiplan Commercial |
$300.99
|
| Rate for Payer: Networks By Design Commercial |
$188.12
|
| Rate for Payer: Prime Health Services Commercial |
$319.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.20
|
| Rate for Payer: United Healthcare All Other HMO |
$137.44
|
| Rate for Payer: United Healthcare HMO Rider |
$134.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$319.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$319.80
|
| Rate for Payer: Vantage Medical Group Senior |
$319.80
|
|
|
HC CATH HEMO KIT 12FRX16CM UBEND
|
Facility
|
IP
|
$895.85
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.17 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$179.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$403.13
|
| Rate for Payer: Cash Price |
$403.13
|
| Rate for Payer: Cigna of CA HMO |
$627.10
|
| Rate for Payer: Cigna of CA PPO |
$627.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$627.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.34
|
| Rate for Payer: EPIC Health Plan Senior |
$358.34
|
| Rate for Payer: Galaxy Health WC |
$761.47
|
| Rate for Payer: Global Benefits Group Commercial |
$537.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$568.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$528.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$716.68
|
| Rate for Payer: Networks By Design Commercial |
$447.93
|
| Rate for Payer: Prime Health Services Commercial |
$761.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.21
|
| Rate for Payer: United Healthcare All Other HMO |
$327.25
|
| Rate for Payer: United Healthcare HMO Rider |
$320.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.39
|
|
|
HC CATH HEMO KIT 12FRX16CM UBEND
|
Facility
|
OP
|
$895.85
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.17 |
| Max. Negotiated Rate |
$761.47 |
| Rate for Payer: Adventist Health Commercial |
$179.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$671.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$542.26
|
| Rate for Payer: Blue Shield of California Commercial |
$454.20
|
| Rate for Payer: Blue Shield of California Commercial |
$688.91
|
| Rate for Payer: Cash Price |
$403.13
|
| Rate for Payer: Cigna of CA HMO |
$627.10
|
| Rate for Payer: Cigna of CA PPO |
$627.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$761.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$761.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$627.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.34
|
| Rate for Payer: EPIC Health Plan Senior |
$358.34
|
| Rate for Payer: Galaxy Health WC |
$761.47
|
| Rate for Payer: Global Benefits Group Commercial |
$537.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$568.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$325.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$528.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.10
|
| Rate for Payer: Multiplan Commercial |
$716.68
|
| Rate for Payer: Networks By Design Commercial |
$447.93
|
| Rate for Payer: Prime Health Services Commercial |
$761.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.21
|
| Rate for Payer: United Healthcare All Other HMO |
$327.25
|
| Rate for Payer: United Healthcare HMO Rider |
$320.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$761.47
|
| Rate for Payer: Vantage Medical Group Senior |
$761.47
|
|
|
HC CATH HEMO KIT 12FRX20CM UBEND
|
Facility
|
IP
|
$258.44
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.69 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$51.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$116.30
|
| Rate for Payer: Cash Price |
$116.30
|
| Rate for Payer: Cigna of CA HMO |
$180.91
|
| Rate for Payer: Cigna of CA PPO |
$180.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.38
|
| Rate for Payer: EPIC Health Plan Senior |
$103.38
|
| Rate for Payer: Galaxy Health WC |
$219.67
|
| Rate for Payer: Global Benefits Group Commercial |
$155.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$164.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.03
|
| Rate for Payer: Multiplan Commercial |
$206.75
|
| Rate for Payer: Networks By Design Commercial |
$129.22
|
| Rate for Payer: Prime Health Services Commercial |
$219.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.99
|
| Rate for Payer: United Healthcare All Other HMO |
$94.41
|
| Rate for Payer: United Healthcare HMO Rider |
$92.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.64
|
|
|
HC CATH HEMO KIT 12FRX20CM UBEND
|
Facility
|
OP
|
$258.44
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.69 |
| Max. Negotiated Rate |
$219.67 |
| Rate for Payer: Adventist Health Commercial |
$51.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.43
|
| Rate for Payer: Blue Shield of California Commercial |
$131.03
|
| Rate for Payer: Blue Shield of California Commercial |
$198.74
|
| Rate for Payer: Cash Price |
$116.30
|
| Rate for Payer: Cigna of CA HMO |
$180.91
|
| Rate for Payer: Cigna of CA PPO |
$180.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.38
|
| Rate for Payer: EPIC Health Plan Senior |
$103.38
|
| Rate for Payer: Galaxy Health WC |
$219.67
|
| Rate for Payer: Global Benefits Group Commercial |
$155.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$164.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$180.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.91
|
| Rate for Payer: Multiplan Commercial |
$206.75
|
| Rate for Payer: Networks By Design Commercial |
$129.22
|
| Rate for Payer: Prime Health Services Commercial |
$219.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.99
|
| Rate for Payer: United Healthcare All Other HMO |
$94.41
|
| Rate for Payer: United Healthcare HMO Rider |
$92.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.67
|
| Rate for Payer: Vantage Medical Group Senior |
$219.67
|
|
