|
HC CNTRL VNS CATH KIT DL 8FR 16CM
|
Facility
|
IP
|
$680.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.04 |
| Max. Negotiated Rate |
$578.17 |
| Rate for Payer: Adventist Health Commercial |
$136.04
|
| Rate for Payer: Cash Price |
$306.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.08
|
| Rate for Payer: EPIC Health Plan Senior |
$272.08
|
| Rate for Payer: Galaxy Health WC |
$578.17
|
| Rate for Payer: Global Benefits Group Commercial |
$408.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.25
|
| Rate for Payer: Multiplan Commercial |
$544.16
|
| Rate for Payer: Networks By Design Commercial |
$442.13
|
| Rate for Payer: Prime Health Services Commercial |
$578.17
|
|
|
HC CNTRL VNS CATH KIT DL 8FR 16CM
|
Facility
|
OP
|
$680.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.04 |
| Max. Negotiated Rate |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$136.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$578.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$374.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.48
|
| Rate for Payer: Cash Price |
$306.09
|
| Rate for Payer: Cash Price |
$306.09
|
| Rate for Payer: Cigna of CA HMO |
$435.33
|
| Rate for Payer: Cigna of CA PPO |
$503.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$578.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$578.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$578.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.08
|
| Rate for Payer: EPIC Health Plan Senior |
$272.08
|
| Rate for Payer: Galaxy Health WC |
$578.17
|
| Rate for Payer: Global Benefits Group Commercial |
$408.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$476.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$476.14
|
| Rate for Payer: Multiplan Commercial |
$544.16
|
| Rate for Payer: Networks By Design Commercial |
$442.13
|
| Rate for Payer: Prime Health Services Commercial |
$578.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.10
|
| Rate for Payer: United Healthcare All Other HMO |
$340.10
|
| Rate for Payer: United Healthcare HMO Rider |
$340.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$578.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$578.17
|
| Rate for Payer: Vantage Medical Group Senior |
$578.17
|
|
|
HC CNTRL VNS CATH KIT MAC DL 9FR
|
Facility
|
OP
|
$881.45
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.29 |
| Max. Negotiated Rate |
$749.23 |
| Rate for Payer: Adventist Health Commercial |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.54
|
| Rate for Payer: Blue Shield of California Commercial |
$446.90
|
| Rate for Payer: Blue Shield of California Commercial |
$677.84
|
| Rate for Payer: Cash Price |
$396.65
|
| Rate for Payer: Cigna of CA HMO |
$617.01
|
| Rate for Payer: Cigna of CA PPO |
$617.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.58
|
| Rate for Payer: EPIC Health Plan Senior |
$352.58
|
| Rate for Payer: Galaxy Health WC |
$749.23
|
| Rate for Payer: Global Benefits Group Commercial |
$528.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.01
|
| Rate for Payer: Multiplan Commercial |
$705.16
|
| Rate for Payer: Networks By Design Commercial |
$440.73
|
| Rate for Payer: Prime Health Services Commercial |
$749.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.81
|
| Rate for Payer: United Healthcare All Other HMO |
$321.99
|
| Rate for Payer: United Healthcare HMO Rider |
$315.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.23
|
| Rate for Payer: Vantage Medical Group Senior |
$749.23
|
|
|
HC CNTRL VNS CATH KIT MAC DL 9FR
|
Facility
|
IP
|
$881.45
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.29 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$176.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$396.65
|
| Rate for Payer: Cash Price |
$396.65
|
| Rate for Payer: Cigna of CA HMO |
$617.01
|
| Rate for Payer: Cigna of CA PPO |
$617.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.58
|
| Rate for Payer: EPIC Health Plan Senior |
$352.58
|
| Rate for Payer: Galaxy Health WC |
$749.23
|
| Rate for Payer: Global Benefits Group Commercial |
$528.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.55
|
| Rate for Payer: Multiplan Commercial |
$705.16
|
| Rate for Payer: Networks By Design Commercial |
$440.73
|
| Rate for Payer: Prime Health Services Commercial |
$749.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.81
|
| Rate for Payer: United Healthcare All Other HMO |
$321.99
|
| Rate for Payer: United Healthcare HMO Rider |
$315.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.67
|
|
|
HC CNTRL VNS CATH KIT QL 8.5FR
|
Facility
|
OP
|
$752.56
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.51 |
| Max. Negotiated Rate |
$639.68 |
| Rate for Payer: Adventist Health Commercial |
$150.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$639.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$413.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$564.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$455.52
|
| Rate for Payer: Blue Shield of California Commercial |
$381.55
|
| Rate for Payer: Blue Shield of California Commercial |
$578.72
|
| Rate for Payer: Cash Price |
$338.65
|
| Rate for Payer: Cigna of CA HMO |
$526.79
|
| Rate for Payer: Cigna of CA PPO |
$526.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$639.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$639.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$639.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$526.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.02
|
| Rate for Payer: EPIC Health Plan Senior |
$301.02
|
| Rate for Payer: Galaxy Health WC |
$639.68
|
| Rate for Payer: Global Benefits Group Commercial |
$451.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$477.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$444.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$526.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$526.79
|
| Rate for Payer: Multiplan Commercial |
$602.05
|
| Rate for Payer: Networks By Design Commercial |
$376.28
|
| Rate for Payer: Prime Health Services Commercial |
$639.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$451.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$451.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.44
|
| Rate for Payer: United Healthcare All Other HMO |
$274.91
|
| Rate for Payer: United Healthcare HMO Rider |
$268.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$639.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$639.68
|
| Rate for Payer: Vantage Medical Group Senior |
$639.68
|
|
|
HC CNTRL VNS CATH KIT QL 8.5FR
|
Facility
|
OP
|
$792.90
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.58 |
| Max. Negotiated Rate |
$673.97 |
| Rate for Payer: Adventist Health Commercial |
$158.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$436.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$479.94
|
| Rate for Payer: Blue Shield of California Commercial |
$402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$609.74
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cigna of CA HMO |
$555.03
|
| Rate for Payer: Cigna of CA PPO |
$555.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.16
|
| Rate for Payer: EPIC Health Plan Senior |
$317.16
|
| Rate for Payer: Galaxy Health WC |
$673.97
|
| Rate for Payer: Global Benefits Group Commercial |
$475.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$503.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$555.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$555.03
|
| Rate for Payer: Multiplan Commercial |
$634.32
|
| Rate for Payer: Networks By Design Commercial |
$396.45
|
| Rate for Payer: Prime Health Services Commercial |
$673.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.58
|
| Rate for Payer: United Healthcare All Other HMO |
$289.65
|
| Rate for Payer: United Healthcare HMO Rider |
$283.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.97
|
| Rate for Payer: Vantage Medical Group Senior |
$673.97
|
|
|
HC CNTRL VNS CATH KIT QL 8.5FR
|
Facility
|
IP
|
$752.56
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.51 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$150.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$338.65
|
| Rate for Payer: Cash Price |
$338.65
|
| Rate for Payer: Cigna of CA HMO |
$526.79
|
| Rate for Payer: Cigna of CA PPO |
$526.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$526.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.02
|
| Rate for Payer: EPIC Health Plan Senior |
$301.02
|
| Rate for Payer: Galaxy Health WC |
$639.68
|
| Rate for Payer: Global Benefits Group Commercial |
$451.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$477.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$444.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.61
|
| Rate for Payer: Multiplan Commercial |
$602.05
|
| Rate for Payer: Networks By Design Commercial |
$376.28
|
| Rate for Payer: Prime Health Services Commercial |
$639.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.44
|
| Rate for Payer: United Healthcare All Other HMO |
$274.91
|
| Rate for Payer: United Healthcare HMO Rider |
$268.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.46
|
|
|
HC CNTRL VNS CATH KIT QL 8.5FR
|
Facility
|
IP
|
$792.90
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.58 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$158.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cigna of CA HMO |
$555.03
|
| Rate for Payer: Cigna of CA PPO |
$555.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.16
|
| Rate for Payer: EPIC Health Plan Senior |
$317.16
|
| Rate for Payer: Galaxy Health WC |
$673.97
|
| Rate for Payer: Global Benefits Group Commercial |
$475.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$503.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.30
|
| Rate for Payer: Multiplan Commercial |
$634.32
|
| Rate for Payer: Networks By Design Commercial |
$396.45
|
| Rate for Payer: Prime Health Services Commercial |
$673.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.58
|
| Rate for Payer: United Healthcare All Other HMO |
$289.65
|
| Rate for Payer: United Healthcare HMO Rider |
$283.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.67
|
|
|
HC CNTRL VNS CATH KIT TL 7FR 16CM
|
Facility
|
IP
|
$705.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.07 |
| Max. Negotiated Rate |
$599.56 |
| Rate for Payer: Adventist Health Commercial |
$141.07
|
| Rate for Payer: Cash Price |
$317.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$493.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.14
|
| Rate for Payer: EPIC Health Plan Senior |
$282.14
|
| Rate for Payer: Galaxy Health WC |
$599.56
|
| Rate for Payer: Global Benefits Group Commercial |
$423.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$416.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.29
|
| Rate for Payer: Multiplan Commercial |
$564.29
|
| Rate for Payer: Networks By Design Commercial |
$458.48
|
| Rate for Payer: Prime Health Services Commercial |
$599.56
|
|
|
HC CNTRL VNS CATH KIT TL 7FR 16CM
|
Facility
|
OP
|
$705.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.07 |
| Max. Negotiated Rate |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$141.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$599.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$529.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$452.63
|
| Rate for Payer: Cash Price |
$317.41
|
| Rate for Payer: Cash Price |
$317.41
|
| Rate for Payer: Cigna of CA HMO |
$451.43
|
| Rate for Payer: Cigna of CA PPO |
$521.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$599.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$599.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$599.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$493.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.14
|
| Rate for Payer: EPIC Health Plan Senior |
$282.14
|
| Rate for Payer: Galaxy Health WC |
$599.56
|
| Rate for Payer: Global Benefits Group Commercial |
$423.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$416.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$493.75
|
| Rate for Payer: Multiplan Commercial |
$564.29
|
| Rate for Payer: Networks By Design Commercial |
$458.48
|
| Rate for Payer: Prime Health Services Commercial |
$599.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.68
|
| Rate for Payer: United Healthcare All Other HMO |
$352.68
|
| Rate for Payer: United Healthcare HMO Rider |
$352.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$599.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$599.56
|
| Rate for Payer: Vantage Medical Group Senior |
$599.56
|
|
|
HC CNTRL VNS CATH KIT TL 7FR 20CM
|
Facility
|
IP
|
$705.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.07 |
| Max. Negotiated Rate |
$599.56 |
| Rate for Payer: Adventist Health Commercial |
$141.07
|
| Rate for Payer: Cash Price |
$317.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$493.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.14
|
| Rate for Payer: EPIC Health Plan Senior |
$282.14
|
| Rate for Payer: Galaxy Health WC |
$599.56
|
| Rate for Payer: Global Benefits Group Commercial |
$423.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$416.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.29
|
| Rate for Payer: Multiplan Commercial |
$564.29
|
| Rate for Payer: Networks By Design Commercial |
$458.48
|
| Rate for Payer: Prime Health Services Commercial |
$599.56
|
|
|
HC CNTRL VNS CATH KIT TL 7FR 20CM
|
Facility
|
OP
|
$705.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.07 |
| Max. Negotiated Rate |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$141.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$599.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$529.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$452.63
|
| Rate for Payer: Cash Price |
$317.41
|
| Rate for Payer: Cash Price |
$317.41
|
| Rate for Payer: Cigna of CA HMO |
$451.43
|
| Rate for Payer: Cigna of CA PPO |
$521.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$599.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$599.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$599.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$493.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.14
|
| Rate for Payer: EPIC Health Plan Senior |
$282.14
|
| Rate for Payer: Galaxy Health WC |
$599.56
|
| Rate for Payer: Global Benefits Group Commercial |
$423.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$416.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$493.75
|
| Rate for Payer: Multiplan Commercial |
$564.29
|
| Rate for Payer: Networks By Design Commercial |
$458.48
|
| Rate for Payer: Prime Health Services Commercial |
$599.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.68
|
| Rate for Payer: United Healthcare All Other HMO |
$352.68
|
| Rate for Payer: United Healthcare HMO Rider |
$352.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$599.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$599.56
|
| Rate for Payer: Vantage Medical Group Senior |
$599.56
|
|
|
HC CNTR VISIPAQUE 320 50ML PER ML
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
906812679
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
HC CNTR VISIPAQUE 320 50ML PER ML
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
906812679
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
HC CNVRT NEHPU TO NEPH CATH PERCU
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
909050434
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cigna of CA HMO |
$438.40
|
| Rate for Payer: Cigna of CA PPO |
$506.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$479.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$582.25
|
| Rate for Payer: Global Benefits Group Commercial |
$411.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,387.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,569.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$548.00
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$445.25
|
| Rate for Payer: Prime Health Services Commercial |
$582.25
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$342.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CNVRT NEHPU TO NEPH CATH PERCU
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
909050434
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$582.25 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$479.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.00
|
| Rate for Payer: EPIC Health Plan Senior |
$274.00
|
| Rate for Payer: Galaxy Health WC |
$582.25
|
| Rate for Payer: Global Benefits Group Commercial |
$411.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$404.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.40
|
| Rate for Payer: Multiplan Commercial |
$548.00
|
| Rate for Payer: Networks By Design Commercial |
$445.25
|
| Rate for Payer: Prime Health Services Commercial |
$582.25
|
|
|
HC CO2
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| 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
|
|
|
HC CO2
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$48.99 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Blue Shield of California Commercial |
$45.18
|
| Rate for Payer: Blue Shield of California Commercial |
$11.85
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.37
|
| Rate for Payer: EPIC Health Plan Senior |
$5.37
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC CO2 INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC CO2 INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$48.99 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.37
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC CO57 CYANOCOBALAMIN UP TO 1MCI
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT A9559
|
| Hospital Charge Code |
909301530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$335.75 |
| Rate for Payer: Adventist Health Commercial |
$79.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$335.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$296.25
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cigna of CA HMO |
$276.50
|
| Rate for Payer: Cigna of CA PPO |
$276.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$276.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.00
|
| Rate for Payer: EPIC Health Plan Senior |
$158.00
|
| Rate for Payer: Galaxy Health WC |
$335.75
|
| Rate for Payer: Global Benefits Group Commercial |
$237.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$250.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$276.50
|
| Rate for Payer: Multiplan Commercial |
$316.00
|
| Rate for Payer: Networks By Design Commercial |
$197.50
|
| Rate for Payer: Prime Health Services Commercial |
$335.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$237.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$237.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.24
|
| Rate for Payer: United Healthcare All Other HMO |
$144.29
|
| Rate for Payer: United Healthcare HMO Rider |
$141.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$335.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.75
|
| Rate for Payer: Vantage Medical Group Senior |
$335.75
|
|
|
HC CO57 CYANOCOBALAMIN UP TO 1MCI
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT A9559
|
| Hospital Charge Code |
909301530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$335.75 |
| Rate for Payer: Adventist Health Commercial |
$79.00
|
| Rate for Payer: Blue Shield of California Commercial |
$200.26
|
| Rate for Payer: Blue Shield of California Commercial |
$303.75
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cigna of CA HMO |
$276.50
|
| Rate for Payer: Cigna of CA PPO |
$276.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$276.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.00
|
| Rate for Payer: EPIC Health Plan Senior |
$158.00
|
| Rate for Payer: Galaxy Health WC |
$335.75
|
| Rate for Payer: Global Benefits Group Commercial |
$237.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$250.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$316.00
|
| Rate for Payer: Networks By Design Commercial |
$197.50
|
| Rate for Payer: Prime Health Services Commercial |
$335.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.24
|
| Rate for Payer: United Healthcare All Other HMO |
$144.29
|
| Rate for Payer: United Healthcare HMO Rider |
$141.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.36
|
|
|
HC COAG FVIII INHIB EVAL BTHSDA U
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913970
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Shield of California Commercial |
$61.31
|
| Rate for Payer: Blue Shield of California Commercial |
$92.70
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC COAG FVIII INHIB EVAL BTHSDA U
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913970
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.92
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC COAG TIME ACTIVATED
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900910011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$43.92 |
| Rate for Payer: Cigna of CA HMO |
$181.76
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Cigna of CA PPO |
$210.16
|
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.92
|
| Rate for Payer: Blue Shield of California Commercial |
$130.92
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$197.95
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.71
|
| Rate for Payer: EPIC Health Plan Senior |
$4.71
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
