|
HC CMV ANTIBODY IGM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
900913651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$159.33 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.33
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC CMV ANTIBODY IGM
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
900913651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC CMV DNA QUANT PCR TEST
|
Facility
|
OP
|
$264.19
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900913695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$52.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$176.74
|
| Rate for Payer: Blue Shield of California EPN |
$116.77
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cash Price |
$118.89
|
| Rate for Payer: Cigna of CA HMO |
$169.08
|
| Rate for Payer: Cigna of CA PPO |
$195.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$224.56
|
| Rate for Payer: Global Benefits Group Commercial |
$158.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$211.35
|
| Rate for Payer: Networks By Design Commercial |
$171.72
|
| Rate for Payer: Prime Health Services Commercial |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC CMV DNA QUANT PCR TEST
|
Facility
|
IP
|
$290.61
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900913695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.12 |
| Max. Negotiated Rate |
$247.02 |
| Rate for Payer: Adventist Health Commercial |
$58.12
|
| Rate for Payer: Cash Price |
$130.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.24
|
| Rate for Payer: EPIC Health Plan Senior |
$116.24
|
| Rate for Payer: Galaxy Health WC |
$247.02
|
| Rate for Payer: Global Benefits Group Commercial |
$174.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$232.49
|
| Rate for Payer: Networks By Design Commercial |
$188.90
|
| Rate for Payer: Prime Health Services Commercial |
$247.02
|
|
|
HC CNP VENTILATION
|
Facility
|
OP
|
$4,135.00
|
|
|
Service Code
|
CPT 94662
|
| Hospital Charge Code |
900800105
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$3,514.75 |
| Rate for Payer: Adventist Health Commercial |
$827.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,712.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$1,860.75
|
| Rate for Payer: Cash Price |
$1,860.75
|
| Rate for Payer: Cash Price |
$1,860.75
|
| Rate for Payer: Cash Price |
$1,860.75
|
| Rate for Payer: Cigna of CA HMO |
$2,646.40
|
| Rate for Payer: Cigna of CA PPO |
$3,059.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.99
|
| Rate for Payer: EPIC Health Plan Senior |
$839.99
|
| Rate for Payer: Galaxy Health WC |
$3,514.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,481.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,377.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,758.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,125.59
|
| Rate for Payer: Multiplan Commercial |
$3,308.00
|
| Rate for Payer: Networks By Design Commercial |
$2,687.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,514.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,481.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,481.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$839.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC CNP VENTILATION
|
Facility
|
IP
|
$4,135.00
|
|
|
Service Code
|
CPT 94662
|
| Hospital Charge Code |
900800105
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$827.00 |
| Max. Negotiated Rate |
$3,514.75 |
| Rate for Payer: Adventist Health Commercial |
$827.00
|
| Rate for Payer: Cash Price |
$1,860.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,654.00
|
| Rate for Payer: Galaxy Health WC |
$3,514.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,481.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,758.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,559.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.40
|
| Rate for Payer: Multiplan Commercial |
$3,308.00
|
| Rate for Payer: Networks By Design Commercial |
$2,687.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,514.75
|
|
|
HC CNTR BRACCO ISOVUE 370 50ML
|
Facility
|
OP
|
$3.78
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
906812530
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.32
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.46
|
| Rate for Payer: Prime Health Services Commercial |
$3.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.21
|
|
|
HC CNTR BRACCO ISOVUE 370 50ML
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
906812530
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.46
|
| Rate for Payer: Prime Health Services Commercial |
$3.21
|
|
|
HC CNTRL LINE DRSNG KIT CHG PEDS
|
Facility
|
OP
|
$297.85
|
|
| Hospital Charge Code |
901698280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$253.17 |
| Rate for Payer: Adventist Health Commercial |
$59.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$195.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.91
|
| Rate for Payer: Cash Price |
$134.03
|
| Rate for Payer: Cigna of CA HMO |
$190.62
|
| Rate for Payer: Cigna of CA PPO |
$220.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.14
|
| Rate for Payer: EPIC Health Plan Senior |
$119.14
|
| Rate for Payer: Galaxy Health WC |
$253.17
|
| Rate for Payer: Global Benefits Group Commercial |
$178.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.50
|
| Rate for Payer: Multiplan Commercial |
$238.28
|
| Rate for Payer: Networks By Design Commercial |
$193.60
|
| Rate for Payer: Prime Health Services Commercial |
$253.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.93
|
| Rate for Payer: United Healthcare All Other HMO |
$148.93
|
| Rate for Payer: United Healthcare HMO Rider |
$148.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.17
|
| Rate for Payer: Vantage Medical Group Senior |
$253.17
|
|
|
HC CNTRL LINE DRSNG KIT CHG PEDS
|
Facility
|
IP
|
$297.85
|
|
| Hospital Charge Code |
901698280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$253.17 |
| Rate for Payer: Adventist Health Commercial |
$59.57
|
| Rate for Payer: Cash Price |
$134.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.14
|
| Rate for Payer: EPIC Health Plan Senior |
$119.14
|
| Rate for Payer: Galaxy Health WC |
$253.17
|
| Rate for Payer: Global Benefits Group Commercial |
$178.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.48
|
| Rate for Payer: Multiplan Commercial |
$238.28
|
| Rate for Payer: Networks By Design Commercial |
$193.60
|
| Rate for Payer: Prime Health Services Commercial |
$253.17
|
|
|
HC CNTRL NASAL HEMORRHAGE COMPLEX
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC CNTRL NASAL HEMORRHAGE COMPLEX
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.00
|
| Rate for Payer: United Healthcare All Other HMO |
$434.00
|
| Rate for Payer: United Healthcare HMO Rider |
$434.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CNTRL NASAL HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$189.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cigna of CA HMO |
$607.36
|
| Rate for Payer: Cigna of CA PPO |
$702.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$806.65
|
| Rate for Payer: Global Benefits Group Commercial |
$569.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$632.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$759.20
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$616.85
|
| Rate for Payer: Prime Health Services Commercial |
$806.65
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$569.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.50
|
| Rate for Payer: United Healthcare All Other HMO |
$474.50
|
| Rate for Payer: United Healthcare HMO Rider |
$474.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CNTRL NASAL HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.80 |
| Max. Negotiated Rate |
$806.65 |
| Rate for Payer: Adventist Health Commercial |
$189.80
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.60
|
| Rate for Payer: EPIC Health Plan Senior |
$379.60
|
| Rate for Payer: Galaxy Health WC |
$806.65
|
| Rate for Payer: Global Benefits Group Commercial |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$632.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.76
|
| Rate for Payer: Multiplan Commercial |
$759.20
|
| Rate for Payer: Networks By Design Commercial |
$616.85
|
| Rate for Payer: Prime Health Services Commercial |
$806.65
|
|
|
HC CNTRL NASAL HEM POSTERIOR
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
900501116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$189.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cigna of CA HMO |
$607.36
|
| Rate for Payer: Cigna of CA PPO |
$702.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$806.65
|
| Rate for Payer: Global Benefits Group Commercial |
$569.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$632.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$759.20
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$616.85
|
| Rate for Payer: Prime Health Services Commercial |
$806.65
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$569.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.50
|
| Rate for Payer: United Healthcare All Other HMO |
$474.50
|
| Rate for Payer: United Healthcare HMO Rider |
$474.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$474.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CNTRL NASAL HEM POSTERIOR
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
900501116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.80 |
| Max. Negotiated Rate |
$806.65 |
| Rate for Payer: Adventist Health Commercial |
$189.80
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.60
|
| Rate for Payer: EPIC Health Plan Senior |
$379.60
|
| Rate for Payer: Galaxy Health WC |
$806.65
|
| Rate for Payer: Global Benefits Group Commercial |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$632.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.76
|
| Rate for Payer: Multiplan Commercial |
$759.20
|
| Rate for Payer: Networks By Design Commercial |
$616.85
|
| Rate for Payer: Prime Health Services Commercial |
$806.65
|
|
|
HC CNTRL NASAL HEM POST SUBSQ
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
900501117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.40 |
| Max. Negotiated Rate |
$613.70 |
| Rate for Payer: Adventist Health Commercial |
$144.40
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$288.80
|
| Rate for Payer: Galaxy Health WC |
$613.70
|
| Rate for Payer: Global Benefits Group Commercial |
$433.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$481.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$446.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.28
|
| Rate for Payer: Multiplan Commercial |
$577.60
|
| Rate for Payer: Networks By Design Commercial |
$469.30
|
| Rate for Payer: Prime Health Services Commercial |
$613.70
|
|
|
HC CNTRL NASAL HEM POST SUBSQ
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
900501117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$144.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cigna of CA HMO |
$462.08
|
| Rate for Payer: Cigna of CA PPO |
$534.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$613.70
|
| Rate for Payer: Global Benefits Group Commercial |
$433.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$481.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$577.60
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$469.30
|
| Rate for Payer: Prime Health Services Commercial |
$613.70
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$361.00
|
| Rate for Payer: United Healthcare All Other HMO |
$361.00
|
| Rate for Payer: United Healthcare HMO Rider |
$361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC CNTRL ORO HEM W SURG INTRV
|
Facility
|
IP
|
$5,470.00
|
|
|
Service Code
|
CPT 42962
|
| Hospital Charge Code |
900542962
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,094.00 |
| Max. Negotiated Rate |
$4,649.50 |
| Rate for Payer: Adventist Health Commercial |
$1,094.00
|
| Rate for Payer: Cash Price |
$2,461.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,188.00
|
| Rate for Payer: Galaxy Health WC |
$4,649.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,282.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,648.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,084.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,385.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.80
|
| Rate for Payer: Multiplan Commercial |
$4,376.00
|
| Rate for Payer: Networks By Design Commercial |
$3,555.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,649.50
|
|
|
HC CNTRL ORO HEM W SURG INTRV
|
Facility
|
OP
|
$5,470.00
|
|
|
Service Code
|
CPT 42962
|
| Hospital Charge Code |
900542962
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$783.77 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,094.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,461.50
|
| Rate for Payer: Cash Price |
$2,461.50
|
| Rate for Payer: Cash Price |
$2,461.50
|
| Rate for Payer: Cigna of CA HMO |
$3,500.80
|
| Rate for Payer: Cigna of CA PPO |
$4,047.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$4,649.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,282.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,648.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$783.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$4,376.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,555.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,649.50
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,735.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,735.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,735.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,735.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC CNTRL VNS CATH KIT 2LUMEN 9FR
|
Facility
|
IP
|
$755.96
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.19 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$151.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$340.18
|
| Rate for Payer: Cash Price |
$340.18
|
| Rate for Payer: Cigna of CA HMO |
$529.17
|
| Rate for Payer: Cigna of CA PPO |
$529.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.38
|
| Rate for Payer: EPIC Health Plan Senior |
$302.38
|
| Rate for Payer: Galaxy Health WC |
$642.57
|
| Rate for Payer: Global Benefits Group Commercial |
$453.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.43
|
| Rate for Payer: Multiplan Commercial |
$604.77
|
| Rate for Payer: Networks By Design Commercial |
$377.98
|
| Rate for Payer: Prime Health Services Commercial |
$642.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.71
|
| Rate for Payer: United Healthcare All Other HMO |
$276.15
|
| Rate for Payer: United Healthcare HMO Rider |
$270.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.58
|
|
|
HC CNTRL VNS CATH KIT 2LUMEN 9FR
|
Facility
|
OP
|
$755.96
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.19 |
| Max. Negotiated Rate |
$642.57 |
| Rate for Payer: Adventist Health Commercial |
$151.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$642.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$415.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$566.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.85
|
| Rate for Payer: Blue Shield of California Commercial |
$557.90
|
| Rate for Payer: Blue Shield of California EPN |
$367.40
|
| Rate for Payer: Cash Price |
$340.18
|
| Rate for Payer: Cigna of CA HMO |
$529.17
|
| Rate for Payer: Cigna of CA PPO |
$529.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$642.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$642.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$642.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.38
|
| Rate for Payer: EPIC Health Plan Senior |
$302.38
|
| Rate for Payer: Galaxy Health WC |
$642.57
|
| Rate for Payer: Global Benefits Group Commercial |
$453.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$529.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.17
|
| Rate for Payer: Multiplan Commercial |
$604.77
|
| Rate for Payer: Networks By Design Commercial |
$377.98
|
| Rate for Payer: Prime Health Services Commercial |
$642.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.71
|
| Rate for Payer: United Healthcare All Other HMO |
$276.15
|
| Rate for Payer: United Healthcare HMO Rider |
$270.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$642.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$642.57
|
| Rate for Payer: Vantage Medical Group Senior |
$642.57
|
|
|
HC CNTRL VNS CATH KIT 4FR DL
|
Facility
|
OP
|
$603.38
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$512.87 |
| Rate for Payer: Adventist Health Commercial |
$120.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$512.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$452.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.48
|
| Rate for Payer: Blue Shield of California Commercial |
$445.29
|
| Rate for Payer: Blue Shield of California EPN |
$293.24
|
| Rate for Payer: Cash Price |
$271.52
|
| Rate for Payer: Cigna of CA HMO |
$422.37
|
| Rate for Payer: Cigna of CA PPO |
$422.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$512.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$512.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$512.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.35
|
| Rate for Payer: EPIC Health Plan Senior |
$241.35
|
| Rate for Payer: Galaxy Health WC |
$512.87
|
| Rate for Payer: Global Benefits Group Commercial |
$362.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.37
|
| Rate for Payer: Multiplan Commercial |
$482.70
|
| Rate for Payer: Networks By Design Commercial |
$301.69
|
| Rate for Payer: Prime Health Services Commercial |
$512.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$362.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$362.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.45
|
| Rate for Payer: United Healthcare All Other HMO |
$220.41
|
| Rate for Payer: United Healthcare HMO Rider |
$215.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$512.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$512.87
|
| Rate for Payer: Vantage Medical Group Senior |
$512.87
|
|
|
HC CNTRL VNS CATH KIT 4FR DL
|
Facility
|
IP
|
$603.38
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$120.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$271.52
|
| Rate for Payer: Cash Price |
$271.52
|
| Rate for Payer: Cigna of CA HMO |
$422.37
|
| Rate for Payer: Cigna of CA PPO |
$422.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.35
|
| Rate for Payer: EPIC Health Plan Senior |
$241.35
|
| Rate for Payer: Galaxy Health WC |
$512.87
|
| Rate for Payer: Global Benefits Group Commercial |
$362.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.81
|
| Rate for Payer: Multiplan Commercial |
$482.70
|
| Rate for Payer: Networks By Design Commercial |
$301.69
|
| Rate for Payer: Prime Health Services Commercial |
$512.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.45
|
| Rate for Payer: United Healthcare All Other HMO |
$220.41
|
| Rate for Payer: United Healthcare HMO Rider |
$215.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.61
|
|
|
HC CNTRL VNS CATH KIT DL 4FR
|
Facility
|
OP
|
$422.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$358.90 |
| Rate for Payer: Adventist Health Commercial |
$84.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$358.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$316.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.56
|
| Rate for Payer: Blue Shield of California Commercial |
$311.61
|
| Rate for Payer: Blue Shield of California EPN |
$205.21
|
| Rate for Payer: Cash Price |
$190.01
|
| Rate for Payer: Cigna of CA HMO |
$295.57
|
| Rate for Payer: Cigna of CA PPO |
$295.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$358.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$358.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.90
|
| Rate for Payer: EPIC Health Plan Senior |
$168.90
|
| Rate for Payer: Galaxy Health WC |
$358.90
|
| Rate for Payer: Global Benefits Group Commercial |
$253.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$281.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$295.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$295.57
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: Networks By Design Commercial |
$211.12
|
| Rate for Payer: Prime Health Services Commercial |
$358.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.47
|
| Rate for Payer: United Healthcare All Other HMO |
$154.24
|
| Rate for Payer: United Healthcare HMO Rider |
$150.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$358.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.90
|
| Rate for Payer: Vantage Medical Group Senior |
$358.90
|
|
