|
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 |
$191.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$189.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.73
|
| 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 NASAL HEMORRHAGE COMPLEX
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$355.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$496.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$439.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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: TriValley Medical Group Commercial/Senior |
$520.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC CNTRL NASAL HEMORRHAGE COMPLEX
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| 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: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| 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 |
$171.12 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$439.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$664.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$602.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$559.91
|
| 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 HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$389.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$664.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$806.65
|
| Rate for Payer: Global Benefits Group Commercial |
$569.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$602.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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: TriValley Medical Group Commercial/Senior |
$569.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC CNTRL NASAL HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$664.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$602.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$559.91
|
| 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 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$189.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$664.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$806.65
|
| Rate for Payer: Global Benefits Group Commercial |
$569.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$602.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$664.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$602.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$559.91
|
| 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 |
$171.12 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$806.65
|
| Rate for Payer: Adventist Health Commercial |
$189.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$569.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$602.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC CNTRL NASAL HEM POSTERIOR
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
900501116
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$664.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$602.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$559.91
|
| 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
|
456
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$389.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$630.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$664.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$806.65
|
| Rate for Payer: Global Benefits Group Commercial |
$569.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$602.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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: TriValley Medical Group Commercial/Senior |
$569.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC CNTRL NASAL HEM POST SUBSQ
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
900501117
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$173.28 |
| Max. Negotiated Rate |
$5,641.00 |
| 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: Adventist Health Commercial |
$296.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$835.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$505.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$613.70
|
| Rate for Payer: Global Benefits Group Commercial |
$433.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$458.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$666.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| 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: TriValley Medical Group Commercial/Senior |
$433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$505.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$458.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$425.98
|
| 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
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
900501117
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$505.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$458.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$425.98
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$144.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$505.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$613.70
|
| Rate for Payer: Global Benefits Group Commercial |
$433.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$458.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$666.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| 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 |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,829.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,473.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,227.30
|
| 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 |
$7,035.98 |
| Rate for Payer: Cigna of CA HMO |
$3,500.80
|
| Rate for Payer: Cigna of CA PPO |
$4,047.80
|
| Rate for Payer: Adventist Health Commercial |
$1,094.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,829.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| 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/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,473.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$783.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| 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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
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: EPIC Health Plan Senior |
$302.38
|
| Rate for Payer: Galaxy Health WC |
$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 |
$457.58
|
| Rate for Payer: Blue Shield of California Commercial |
$383.27
|
| Rate for Payer: Blue Shield of California Commercial |
$581.33
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.38
|
| Rate for Payer: Global Benefits Group Commercial |
$453.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$480.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$446.02
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$151.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$480.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$446.02
|
| 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 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 |
$365.23
|
| Rate for Payer: Blue Shield of California Commercial |
$305.91
|
| Rate for Payer: Blue Shield of California Commercial |
$464.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$383.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$355.99
|
| 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 |
$14,109.00 |
| Rate for Payer: Cigna of CA PPO |
$422.37
|
| Rate for Payer: Cigna of CA HMO |
$422.37
|
| Rate for Payer: Adventist Health Commercial |
$120.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$271.52
|
| Rate for Payer: Cash Price |
$271.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$383.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$355.99
|
| 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
|
IP
|
$422.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$84.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$190.01
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$295.57
|
| 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 Foundation Hospitals Commercial/Self Funded |
$268.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$249.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.34
|
| 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: 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
|
|
|
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 |
$255.58
|
| Rate for Payer: Blue Shield of California Commercial |
$214.08
|
| Rate for Payer: Blue Shield of California Commercial |
$324.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$295.57
|
| 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 Foundation Hospitals Commercial/Self Funded |
$268.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$249.12
|
| 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
|
|
