|
HC CATH UMBILICAL VESSEL 5.0FR
|
Facility
|
OP
|
$273.49
|
|
| Hospital Charge Code |
901603823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.70 |
| Max. Negotiated Rate |
$232.47 |
| Rate for Payer: Adventist Health Commercial |
$54.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.50
|
| Rate for Payer: Cash Price |
$123.07
|
| Rate for Payer: Cigna of CA HMO |
$175.03
|
| Rate for Payer: Cigna of CA PPO |
$202.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.40
|
| Rate for Payer: EPIC Health Plan Senior |
$109.40
|
| Rate for Payer: Galaxy Health WC |
$232.47
|
| Rate for Payer: Global Benefits Group Commercial |
$164.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.44
|
| Rate for Payer: Multiplan Commercial |
$218.79
|
| Rate for Payer: Networks By Design Commercial |
$177.77
|
| Rate for Payer: Prime Health Services Commercial |
$232.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.75
|
| Rate for Payer: United Healthcare All Other HMO |
$136.75
|
| Rate for Payer: United Healthcare HMO Rider |
$136.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.47
|
| Rate for Payer: Vantage Medical Group Senior |
$232.47
|
|
|
HC CATH URETHRAL 14FR PVC
|
Facility
|
OP
|
$3.69
|
|
| Hospital Charge Code |
901698527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.37
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO |
$2.36
|
| Rate for Payer: Cigna of CA PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
HC CATH URETHRAL 14FR PVC
|
Facility
|
IP
|
$3.69
|
|
| Hospital Charge Code |
901698527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
|
|
HC CATH URETHRAL PVP KIT 14FR
|
Facility
|
IP
|
$20.66
|
|
| Hospital Charge Code |
901698633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$16.53
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
|
|
HC CATH URETHRAL PVP KIT 14FR
|
Facility
|
OP
|
$20.66
|
|
| Hospital Charge Code |
901698633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.26
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna of CA HMO |
$13.22
|
| Rate for Payer: Cigna of CA PPO |
$15.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$16.53
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.56
|
| Rate for Payer: Vantage Medical Group Senior |
$17.56
|
|
|
HC CATH URETHRAL REDRUBBER 10FR
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
901698973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
HC CATH URETHRAL REDRUBBER 10FR
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC CATH URETHRAL REDRUBBER 10FR
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
901698973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
HC CATH URETHRAL REDRUBBER 10FR
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$388.84 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.63
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC CATH URETHRAL REDRUBBER 12FR
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
901698972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
HC CATH URETHRAL REDRUBBER 12FR
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
901698972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
HC CATH URETHRAL REDRUBBER 12FR
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC CATH URETHRAL REDRUBBER 12FR
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$388.84 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.63
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC CATH URETHRAL REDRUBBER 14FR
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
901698971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
HC CATH URETHRAL REDRUBBER 14FR
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC CATH URETHRAL REDRUBBER 14FR
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
901698971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
HC CATH URETHRAL REDRUBBER 14FR
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$388.84 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.16
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC CATH URETHRAL REDRUBBER 16FR
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC CATH URETHRAL REDRUBBER 16FR
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$388.84 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.63
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC CATH URETHRAL REDRUBBER 16FR
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
901698970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
HC CATH URETHRAL REDRUBBER 16FR
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
901698970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
HC CATH URETHRAL REDRUBBER 18FR
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
901698969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
HC CATH URETHRAL REDRUBBER 18FR
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC CATH URETHRAL REDRUBBER 18FR
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$388.84 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.63
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC CATH URETHRAL REDRUBBER 18FR
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
901698969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
