|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.69
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC INDR PEDIAVASC SUPER 3.3FR
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.56
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC INDR PEDIAVASC SUPER 3.3FR
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$425.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$486.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.94
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO |
$414.72
|
| Rate for Payer: Cigna of CA PPO |
$479.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$550.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$550.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$401.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$453.60
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$324.00
|
| Rate for Payer: United Healthcare HMO Rider |
$324.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$550.80
|
| Rate for Payer: Vantage Medical Group Senior |
$550.80
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$401.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.52
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
|
|
HC INDR SPECT LASER GLIDELIGHT
|
Facility
|
IP
|
$7,238.00
|
|
|
Service Code
|
CPT C2629
|
| Hospital Charge Code |
906812680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$6,152.30 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Cash Price |
$3,980.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,895.20
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,757.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,480.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,737.12
|
| Rate for Payer: Multiplan Commercial |
$5,790.40
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
|
|
HC INDR SPECT LASER GLIDELIGHT
|
Facility
|
OP
|
$7,238.00
|
|
|
Service Code
|
CPT C2629
|
| Hospital Charge Code |
906812680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$6,152.30 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,747.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,152.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,980.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,428.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,444.86
|
| Rate for Payer: Cash Price |
$3,980.90
|
| Rate for Payer: Cigna of CA HMO |
$4,632.32
|
| Rate for Payer: Cigna of CA PPO |
$5,356.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,152.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,152.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,152.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,895.20
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,757.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,480.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,737.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,066.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,066.60
|
| Rate for Payer: Multiplan Commercial |
$5,790.40
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,342.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,342.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,619.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,619.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,619.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,152.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,152.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,152.30
|
|
|
HC INDR SPECT TIGHTRAIL DILA MINI
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC INDR SPECT TIGHTRAIL DILA MINI
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC INDR SPECT TIGHTRAIL DILATOR
|
Facility
|
OP
|
$4,738.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$4,027.30 |
| Rate for Payer: Vantage Medical Group Senior |
$4,027.30
|
| Rate for Payer: Adventist Health Commercial |
$947.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,107.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,027.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,605.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,553.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,909.61
|
| Rate for Payer: Cash Price |
$2,605.90
|
| Rate for Payer: Cigna of CA HMO |
$3,032.32
|
| Rate for Payer: Cigna of CA PPO |
$3,506.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,027.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,027.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,027.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,895.20
|
| Rate for Payer: Galaxy Health WC |
$4,027.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,160.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,932.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,316.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,316.60
|
| Rate for Payer: Multiplan Commercial |
$3,790.40
|
| Rate for Payer: Networks By Design Commercial |
$3,079.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,027.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,842.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,842.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,027.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,027.30
|
|
|
HC INDR SPECT TIGHTRAIL DILATOR
|
Facility
|
IP
|
$4,738.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$4,027.30 |
| Rate for Payer: Adventist Health Commercial |
$947.60
|
| Rate for Payer: Cash Price |
$2,605.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,895.20
|
| Rate for Payer: Galaxy Health WC |
$4,027.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,160.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,932.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.12
|
| Rate for Payer: Multiplan Commercial |
$3,790.40
|
| Rate for Payer: Networks By Design Commercial |
$3,079.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,027.30
|
|
|
HC INDR SPECT TIGHTRAIL SUB-C
|
Facility
|
OP
|
$4,238.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,602.30 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,779.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,330.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,178.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,602.56
|
| Rate for Payer: Cash Price |
$2,330.90
|
| Rate for Payer: Cigna of CA HMO |
$2,712.32
|
| Rate for Payer: Cigna of CA PPO |
$3,136.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,602.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,602.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,966.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,966.60
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,542.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,542.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,119.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,119.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,602.30
|
|
|
HC INDR SPECT TIGHTRAIL SUB-C
|
Facility
|
IP
|
$4,238.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,602.30 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Cash Price |
$2,330.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.12
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
|
|
HC INDR SPECT VISI DIALTOR
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC INDR SPECT VISI DIALTOR
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$678.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$776.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$635.59
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$879.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$879.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$724.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.50
|
| Rate for Payer: United Healthcare All Other HMO |
$517.50
|
| Rate for Payer: United Healthcare HMO Rider |
$517.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$517.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$879.75
|
| Rate for Payer: Vantage Medical Group Senior |
$879.75
|
|
|
HC INDR STJ APEEL CS
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906813541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
|
|
HC INDR STJ APEEL CS
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906813541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,003.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$939.57
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna of CA HMO |
$979.20
|
| Rate for Payer: Cigna of CA PPO |
$1,132.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$765.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC INDR STJ FASTCATH 60 CM
|
Facility
|
OP
|
$478.21
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$406.48 |
| Rate for Payer: Adventist Health Commercial |
$95.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.67
|
| Rate for Payer: Cash Price |
$263.02
|
| Rate for Payer: Cigna of CA HMO |
$306.05
|
| Rate for Payer: Cigna of CA PPO |
$353.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$406.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.28
|
| Rate for Payer: EPIC Health Plan Senior |
$191.28
|
| Rate for Payer: Galaxy Health WC |
$406.48
|
| Rate for Payer: Global Benefits Group Commercial |
$286.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.75
|
| Rate for Payer: Multiplan Commercial |
$382.57
|
| Rate for Payer: Networks By Design Commercial |
$310.84
|
| Rate for Payer: Prime Health Services Commercial |
$406.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.10
|
| Rate for Payer: United Healthcare All Other HMO |
$239.10
|
| Rate for Payer: United Healthcare HMO Rider |
$239.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$406.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.48
|
| Rate for Payer: Vantage Medical Group Senior |
$406.48
|
|
|
HC INDR STJ FASTCATH 60 CM
|
Facility
|
IP
|
$478.21
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$406.48 |
| Rate for Payer: Adventist Health Commercial |
$95.64
|
| Rate for Payer: Cash Price |
$263.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.28
|
| Rate for Payer: EPIC Health Plan Senior |
$191.28
|
| Rate for Payer: Galaxy Health WC |
$406.48
|
| Rate for Payer: Global Benefits Group Commercial |
$286.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.77
|
| Rate for Payer: Multiplan Commercial |
$382.57
|
| Rate for Payer: Networks By Design Commercial |
$310.84
|
| Rate for Payer: Prime Health Services Commercial |
$406.48
|
|
|
HC INDR STJ FASTCATH 63CM 10FR
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.51
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$428.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC INDR STJ FASTCATH 63CM 10FR
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
HC INDR STJ MAXIMUM 021
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC INDR STJ MAXIMUM 021
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC INDR TERUMO BOKARHI KIT
|
Facility
|
IP
|
$572.75
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$486.84 |
| Rate for Payer: Adventist Health Commercial |
$114.55
|
| Rate for Payer: Cash Price |
$315.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.10
|
| Rate for Payer: EPIC Health Plan Senior |
$229.10
|
| Rate for Payer: Galaxy Health WC |
$486.84
|
| Rate for Payer: Global Benefits Group Commercial |
$343.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$354.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.46
|
| Rate for Payer: Multiplan Commercial |
$458.20
|
| Rate for Payer: Networks By Design Commercial |
$372.29
|
| Rate for Payer: Prime Health Services Commercial |
$486.84
|
|
