|
HC CATH PMO LICOX
|
Facility
|
OP
|
$3,776.14
|
|
| Hospital Charge Code |
901695700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$755.23 |
| Max. Negotiated Rate |
$3,209.72 |
| Rate for Payer: Adventist Health Commercial |
$755.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,476.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,209.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,076.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,832.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,423.15
|
| Rate for Payer: Cash Price |
$1,699.26
|
| Rate for Payer: Cigna of CA HMO |
$2,416.73
|
| Rate for Payer: Cigna of CA PPO |
$2,794.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,209.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,209.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,209.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,643.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,510.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1,510.46
|
| Rate for Payer: Galaxy Health WC |
$3,209.72
|
| Rate for Payer: Global Benefits Group Commercial |
$2,265.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,397.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,370.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,227.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,643.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,643.30
|
| Rate for Payer: Multiplan Commercial |
$3,020.91
|
| Rate for Payer: Networks By Design Commercial |
$2,454.49
|
| Rate for Payer: Prime Health Services Commercial |
$3,209.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,265.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,265.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,888.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,888.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,888.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,888.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,209.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,209.72
|
| Rate for Payer: Vantage Medical Group Senior |
$3,209.72
|
|
|
HC CATH POLY PICC KIT 1.4FR
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
901698961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$508.30 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC CATH POLY PICC KIT 1.4FR
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
901698961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$508.30 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$392.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.74
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$508.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$508.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$508.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$418.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$418.60
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$508.30
|
| Rate for Payer: Vantage Medical Group Senior |
$508.30
|
|
|
HC CATH POV EXTND DWELL 2FR 22GA
|
Facility
|
IP
|
$238.00
|
|
| Hospital Charge Code |
901698219
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: Adventist Health Commercial |
$47.60
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.20
|
| Rate for Payer: EPIC Health Plan Senior |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.12
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
|
|
HC CATH POV EXTND DWELL 2FR 22GA
|
Facility
|
OP
|
$238.00
|
|
| Hospital Charge Code |
901698219
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: Adventist Health Commercial |
$47.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.72
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna of CA HMO |
$152.32
|
| Rate for Payer: Cigna of CA PPO |
$176.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$202.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$202.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.20
|
| Rate for Payer: EPIC Health Plan Senior |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.00
|
| Rate for Payer: United Healthcare All Other HMO |
$119.00
|
| Rate for Payer: United Healthcare HMO Rider |
$119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$202.30
|
| Rate for Payer: Vantage Medical Group Senior |
$202.30
|
|
|
HC CATH POWERLINE TUNNELED
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909000028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,251.20 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$891.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,131.97
|
| Rate for Payer: Blue Shield of California Commercial |
$746.30
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,030.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,251.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$534.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,030.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,030.40
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$736.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.44
|
| Rate for Payer: United Healthcare All Other HMO |
$537.72
|
| Rate for Payer: United Healthcare HMO Rider |
$526.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$482.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
HC CATH POWERLINE TUNNELED
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909000028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,030.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$736.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.44
|
| Rate for Payer: United Healthcare All Other HMO |
$537.72
|
| Rate for Payer: United Healthcare HMO Rider |
$526.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$482.08
|
|
|
HC CATH POWER PICC 4FR SL
|
Facility
|
IP
|
$2,087.85
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901606421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.57 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$417.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$939.53
|
| Rate for Payer: Cash Price |
$939.53
|
| Rate for Payer: Cigna of CA HMO |
$1,461.49
|
| Rate for Payer: Cigna of CA PPO |
$1,461.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,461.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.14
|
| Rate for Payer: EPIC Health Plan Senior |
$835.14
|
| Rate for Payer: Galaxy Health WC |
$1,774.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,325.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,231.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.08
|
| Rate for Payer: Multiplan Commercial |
$1,670.28
|
| Rate for Payer: Networks By Design Commercial |
$1,043.92
|
| Rate for Payer: Prime Health Services Commercial |
$1,774.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$783.57
|
| Rate for Payer: United Healthcare All Other HMO |
$762.69
|
| Rate for Payer: United Healthcare HMO Rider |
$746.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$683.77
|
|
|
HC CATH POWER PICC 4FR SL
|
Facility
|
OP
|
$2,087.85
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901606421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.57 |
| Max. Negotiated Rate |
$1,774.67 |
| Rate for Payer: Adventist Health Commercial |
$417.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,774.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,148.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,263.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,058.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,605.56
|
| Rate for Payer: Cash Price |
$939.53
|
| Rate for Payer: Cigna of CA HMO |
$1,461.49
|
| Rate for Payer: Cigna of CA PPO |
$1,461.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,774.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,774.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,774.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,461.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.14
|
| Rate for Payer: EPIC Health Plan Senior |
$835.14
|
| Rate for Payer: Galaxy Health WC |
$1,774.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,325.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$757.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,231.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,461.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,461.49
|
| Rate for Payer: Multiplan Commercial |
$1,670.28
|
| Rate for Payer: Networks By Design Commercial |
$1,043.92
|
| Rate for Payer: Prime Health Services Commercial |
$1,774.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$783.57
|
| Rate for Payer: United Healthcare All Other HMO |
$762.69
|
| Rate for Payer: United Healthcare HMO Rider |
$746.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$683.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,774.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,774.67
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.67
|
|
|
HC CATH POWER PICC TLS 4FR SL
|
Facility
|
IP
|
$1,276.68
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901695316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.34 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$255.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$574.51
|
| Rate for Payer: Cash Price |
$574.51
|
| Rate for Payer: Cigna of CA HMO |
$893.68
|
| Rate for Payer: Cigna of CA PPO |
$893.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$893.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.67
|
| Rate for Payer: EPIC Health Plan Senior |
$510.67
|
| Rate for Payer: Galaxy Health WC |
$1,085.18
|
| Rate for Payer: Global Benefits Group Commercial |
$766.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$810.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$753.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.40
|
| Rate for Payer: Multiplan Commercial |
$1,021.34
|
| Rate for Payer: Networks By Design Commercial |
$638.34
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$479.14
|
| Rate for Payer: United Healthcare All Other HMO |
$466.37
|
| Rate for Payer: United Healthcare HMO Rider |
$456.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.11
|
|
|
HC CATH POWER PICC TLS 4FR SL
|
Facility
|
OP
|
$1,276.68
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901695316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.34 |
| Max. Negotiated Rate |
$1,085.18 |
| Rate for Payer: Adventist Health Commercial |
$255.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,085.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$702.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$957.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$772.77
|
| Rate for Payer: Blue Shield of California Commercial |
$647.28
|
| Rate for Payer: Blue Shield of California Commercial |
$981.77
|
| Rate for Payer: Cash Price |
$574.51
|
| Rate for Payer: Cigna of CA HMO |
$893.68
|
| Rate for Payer: Cigna of CA PPO |
$893.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,085.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,085.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,085.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$893.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.67
|
| Rate for Payer: EPIC Health Plan Senior |
$510.67
|
| Rate for Payer: Galaxy Health WC |
$1,085.18
|
| Rate for Payer: Global Benefits Group Commercial |
$766.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$810.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$463.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$753.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$893.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$893.68
|
| Rate for Payer: Multiplan Commercial |
$1,021.34
|
| Rate for Payer: Networks By Design Commercial |
$638.34
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$766.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$766.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$479.14
|
| Rate for Payer: United Healthcare All Other HMO |
$466.37
|
| Rate for Payer: United Healthcare HMO Rider |
$456.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,085.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,085.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,085.18
|
|
|
HC CATH, PREMICATH 1FR 28G,20CM
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC CATH, PREMICATH 1FR 28G,20CM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC CATH PRIMO MALE 16" 12FR COUDE
|
Facility
|
IP
|
$22.14
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Adventist Health Commercial |
$4.43
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.86
|
| Rate for Payer: EPIC Health Plan Senior |
$8.86
|
| Rate for Payer: Galaxy Health WC |
$18.82
|
| Rate for Payer: Global Benefits Group Commercial |
$13.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Multiplan Commercial |
$17.71
|
| Rate for Payer: Networks By Design Commercial |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.82
|
|
|
HC CATH PRIMO MALE 16" 12FR COUDE
|
Facility
|
OP
|
$22.14
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$388.84 |
| Rate for Payer: Adventist Health Commercial |
$4.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.21
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA PPO |
$16.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.86
|
| Rate for Payer: EPIC Health Plan Senior |
$8.86
|
| Rate for Payer: Galaxy Health WC |
$18.82
|
| Rate for Payer: Global Benefits Group Commercial |
$13.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$17.71
|
| Rate for Payer: Networks By Design Commercial |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.07
|
| Rate for Payer: United Healthcare All Other HMO |
$11.07
|
| Rate for Payer: United Healthcare HMO Rider |
$11.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.82
|
| Rate for Payer: Vantage Medical Group Senior |
$18.82
|
|
|
HC CATH PRIMO MALE 16" 14FR COUDE
|
Facility
|
IP
|
$23.70
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$18.96
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
|
|
HC CATH PRIMO MALE 16" 14FR COUDE
|
Facility
|
OP
|
$23.70
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$388.84 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.21
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cigna of CA HMO |
$15.17
|
| Rate for Payer: Cigna of CA PPO |
$17.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.59
|
| Rate for Payer: Multiplan Commercial |
$18.96
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.85
|
| Rate for Payer: United Healthcare All Other HMO |
$11.85
|
| Rate for Payer: United Healthcare HMO Rider |
$11.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.14
|
| Rate for Payer: Vantage Medical Group Senior |
$20.14
|
|
|
HC CATH PRYTIME ER REBOA
|
Facility
|
OP
|
$5,438.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900502628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$4,622.30 |
| Rate for Payer: Adventist Health Commercial |
$1,087.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,616.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,622.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,990.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,078.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,489.56
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Cigna of CA HMO |
$3,480.32
|
| Rate for Payer: Cigna of CA PPO |
$4,024.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,622.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,622.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,622.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,806.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,453.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,973.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,208.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,305.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,806.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,806.60
|
| Rate for Payer: Multiplan Commercial |
$4,350.40
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,719.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,719.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,719.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,719.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,622.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,622.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,622.30
|
|
|
HC CATH PRYTIME ER REBOA
|
Facility
|
IP
|
$5,438.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900502628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$4,622.30 |
| Rate for Payer: Adventist Health Commercial |
$1,087.60
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,806.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,453.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,208.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,305.12
|
| Rate for Payer: Multiplan Commercial |
$4,350.40
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
|
|
HC CATH PUREWICK EXTERNAL FEMALE
|
Facility
|
IP
|
$124.49
|
|
| Hospital Charge Code |
901698540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$105.82 |
| Rate for Payer: Adventist Health Commercial |
$24.90
|
| Rate for Payer: Cash Price |
$56.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.80
|
| Rate for Payer: EPIC Health Plan Senior |
$49.80
|
| Rate for Payer: Galaxy Health WC |
$105.82
|
| Rate for Payer: Global Benefits Group Commercial |
$74.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.88
|
| Rate for Payer: Multiplan Commercial |
$99.59
|
| Rate for Payer: Networks By Design Commercial |
$80.92
|
| Rate for Payer: Prime Health Services Commercial |
$105.82
|
|
|
HC CATH PUREWICK EXTERNAL FEMALE
|
Facility
|
OP
|
$124.49
|
|
| Hospital Charge Code |
901698540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$105.82 |
| Rate for Payer: Adventist Health Commercial |
$24.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.89
|
| Rate for Payer: Cash Price |
$56.02
|
| Rate for Payer: Cigna of CA HMO |
$79.67
|
| Rate for Payer: Cigna of CA PPO |
$92.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$105.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.80
|
| Rate for Payer: EPIC Health Plan Senior |
$49.80
|
| Rate for Payer: Galaxy Health WC |
$105.82
|
| Rate for Payer: Global Benefits Group Commercial |
$74.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.14
|
| Rate for Payer: Multiplan Commercial |
$99.59
|
| Rate for Payer: Networks By Design Commercial |
$80.92
|
| Rate for Payer: Prime Health Services Commercial |
$105.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.24
|
| Rate for Payer: United Healthcare All Other HMO |
$62.24
|
| Rate for Payer: United Healthcare HMO Rider |
$62.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.82
|
| Rate for Payer: Vantage Medical Group Senior |
$105.82
|
|
|
HC CATH PUREWICK FEMALE EXTERNAL
|
Facility
|
OP
|
$65.03
|
|
| Hospital Charge Code |
901608020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.73
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cigna of CA HMO |
$41.62
|
| Rate for Payer: Cigna of CA PPO |
$48.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.01
|
| Rate for Payer: EPIC Health Plan Senior |
$26.01
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.52
|
| Rate for Payer: Multiplan Commercial |
$52.02
|
| Rate for Payer: Networks By Design Commercial |
$42.27
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.52
|
| Rate for Payer: United Healthcare All Other HMO |
$32.52
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.28
|
| Rate for Payer: Vantage Medical Group Senior |
$55.28
|
|
|
HC CATH PUREWICK FEMALE EXTERNAL
|
Facility
|
IP
|
$65.03
|
|
| Hospital Charge Code |
901608020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.01
|
| Rate for Payer: EPIC Health Plan Senior |
$26.01
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.61
|
| Rate for Payer: Multiplan Commercial |
$52.02
|
| Rate for Payer: Networks By Design Commercial |
$42.27
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
|
|
HC CATH PWR PICC 4.5FR 55CM
|
Facility
|
IP
|
$1,318.27
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.65 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$263.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$593.22
|
| Rate for Payer: Cash Price |
$593.22
|
| Rate for Payer: Cigna of CA HMO |
$922.79
|
| Rate for Payer: Cigna of CA PPO |
$922.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$922.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.31
|
| Rate for Payer: EPIC Health Plan Senior |
$527.31
|
| Rate for Payer: Galaxy Health WC |
$1,120.53
|
| Rate for Payer: Global Benefits Group Commercial |
$790.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$777.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.38
|
| Rate for Payer: Multiplan Commercial |
$1,054.62
|
| Rate for Payer: Networks By Design Commercial |
$659.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$494.75
|
| Rate for Payer: United Healthcare All Other HMO |
$481.56
|
| Rate for Payer: United Healthcare HMO Rider |
$471.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.73
|
|
|
HC CATH PWR PICC 4.5FR 55CM
|
Facility
|
OP
|
$1,318.27
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.65 |
| Max. Negotiated Rate |
$1,120.53 |
| Rate for Payer: Cigna of CA PPO |
$922.79
|
| Rate for Payer: Adventist Health Commercial |
$263.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,120.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$988.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$797.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,013.75
|
| Rate for Payer: Blue Shield of California Commercial |
$668.36
|
| Rate for Payer: Cash Price |
$593.22
|
| Rate for Payer: Cigna of CA HMO |
$922.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,120.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,120.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,120.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$922.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.31
|
| Rate for Payer: EPIC Health Plan Senior |
$527.31
|
| Rate for Payer: Galaxy Health WC |
$1,120.53
|
| Rate for Payer: Global Benefits Group Commercial |
$790.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$777.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$922.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$922.79
|
| Rate for Payer: Multiplan Commercial |
$1,054.62
|
| Rate for Payer: Networks By Design Commercial |
$659.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$790.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$790.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$494.75
|
| Rate for Payer: United Healthcare All Other HMO |
$481.56
|
| Rate for Payer: United Healthcare HMO Rider |
$471.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,120.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,120.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,120.53
|
|
