|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
915355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.16 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$505.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.73
|
| Rate for Payer: Blue Shield of California Commercial |
$910.69
|
| Rate for Payer: Blue Shield of California EPN |
$599.72
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$863.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$863.80
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.16 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$505.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.73
|
| Rate for Payer: Blue Shield of California Commercial |
$910.69
|
| Rate for Payer: Blue Shield of California EPN |
$599.72
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$863.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$863.80
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
915355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
OP
|
$1,553.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$129.38 |
| Max. Negotiated Rate |
$1,320.05 |
| Rate for Payer: Adventist Health Commercial |
$310.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,018.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$953.70
|
| Rate for Payer: Blue Shield of California Commercial |
$950.44
|
| Rate for Payer: Blue Shield of California EPN |
$627.41
|
| Rate for Payer: Cash Price |
$698.85
|
| Rate for Payer: Cash Price |
$698.85
|
| Rate for Payer: Cigna of CA HMO |
$993.92
|
| Rate for Payer: Cigna of CA PPO |
$1,149.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,320.05
|
| Rate for Payer: Global Benefits Group Commercial |
$931.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,009.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,320.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$931.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$931.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.89
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$409.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
IP
|
$1,553.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$310.60 |
| Max. Negotiated Rate |
$1,320.05 |
| Rate for Payer: Adventist Health Commercial |
$310.60
|
| Rate for Payer: Cash Price |
$698.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$621.20
|
| Rate for Payer: EPIC Health Plan Senior |
$621.20
|
| Rate for Payer: Galaxy Health WC |
$1,320.05
|
| Rate for Payer: Global Benefits Group Commercial |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$961.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.72
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,009.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,320.05
|
|
|
HC KIDNEY SCAN
|
Facility
|
OP
|
$2,426.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$201.31 |
| Max. Negotiated Rate |
$2,062.10 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,591.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,489.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,484.71
|
| Rate for Payer: Blue Shield of California EPN |
$980.10
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cigna of CA HMO |
$1,552.64
|
| Rate for Payer: Cigna of CA PPO |
$1,795.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,940.80
|
| Rate for Payer: Networks By Design Commercial |
$1,576.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC KIDNEY SCAN
|
Facility
|
IP
|
$2,426.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$2,062.10 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$970.40
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$924.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.24
|
| Rate for Payer: Multiplan Commercial |
$1,940.80
|
| Rate for Payer: Networks By Design Commercial |
$1,576.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
|
|
HC KIT, ADULT CENTRAL LINE DRES CHANGE
|
Facility
|
OP
|
$194.81
|
|
| Hospital Charge Code |
901607207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$165.59 |
| Rate for Payer: Adventist Health Commercial |
$38.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.63
|
| Rate for Payer: Cash Price |
$87.66
|
| Rate for Payer: Cigna of CA HMO |
$124.68
|
| Rate for Payer: Cigna of CA PPO |
$144.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.92
|
| Rate for Payer: EPIC Health Plan Senior |
$77.92
|
| Rate for Payer: Galaxy Health WC |
$165.59
|
| Rate for Payer: Global Benefits Group Commercial |
$116.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.37
|
| Rate for Payer: Multiplan Commercial |
$155.85
|
| Rate for Payer: Networks By Design Commercial |
$126.63
|
| Rate for Payer: Prime Health Services Commercial |
$165.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.41
|
| Rate for Payer: United Healthcare All Other HMO |
$97.41
|
| Rate for Payer: United Healthcare HMO Rider |
$97.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.59
|
| Rate for Payer: Vantage Medical Group Senior |
$165.59
|
|
|
HC KIT, ADULT CENTRAL LINE DRES CHANGE
|
Facility
|
IP
|
$194.81
|
|
| Hospital Charge Code |
901607207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$165.59 |
| Rate for Payer: Adventist Health Commercial |
$38.96
|
| Rate for Payer: Cash Price |
$87.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.92
|
| Rate for Payer: EPIC Health Plan Senior |
$77.92
|
| Rate for Payer: Galaxy Health WC |
$165.59
|
| Rate for Payer: Global Benefits Group Commercial |
$116.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.75
|
| Rate for Payer: Multiplan Commercial |
$155.85
|
| Rate for Payer: Networks By Design Commercial |
$126.63
|
| Rate for Payer: Prime Health Services Commercial |
$165.59
|
|
|
HC KIT, ARTERIAL LINE DRSNG CHNG
|
Facility
|
IP
|
$85.27
|
|
| Hospital Charge Code |
901607861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$72.48 |
| Rate for Payer: Adventist Health Commercial |
$17.05
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: EPIC Health Plan Senior |
$34.11
|
| Rate for Payer: Galaxy Health WC |
$72.48
|
| Rate for Payer: Global Benefits Group Commercial |
$51.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Networks By Design Commercial |
$55.43
|
| Rate for Payer: Prime Health Services Commercial |
$72.48
|
|
|
HC KIT, ARTERIAL LINE DRSNG CHNG
|
Facility
|
OP
|
$85.27
|
|
| Hospital Charge Code |
901607861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$72.48 |
| Rate for Payer: Adventist Health Commercial |
$17.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.36
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cigna of CA HMO |
$54.57
|
| Rate for Payer: Cigna of CA PPO |
$63.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: EPIC Health Plan Senior |
$34.11
|
| Rate for Payer: Galaxy Health WC |
$72.48
|
| Rate for Payer: Global Benefits Group Commercial |
$51.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.69
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Networks By Design Commercial |
$55.43
|
| Rate for Payer: Prime Health Services Commercial |
$72.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.63
|
| Rate for Payer: United Healthcare All Other HMO |
$42.63
|
| Rate for Payer: United Healthcare HMO Rider |
$42.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.48
|
| Rate for Payer: Vantage Medical Group Senior |
$72.48
|
|
|
HC KIT CATH CNTRL VNS 2.5FR
|
Facility
|
IP
|
$281.33
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna of CA HMO |
$196.93
|
| Rate for Payer: Cigna of CA PPO |
$196.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.53
|
| Rate for Payer: EPIC Health Plan Senior |
$112.53
|
| Rate for Payer: Galaxy Health WC |
$239.13
|
| Rate for Payer: Global Benefits Group Commercial |
$168.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.52
|
| Rate for Payer: Multiplan Commercial |
$225.06
|
| Rate for Payer: Networks By Design Commercial |
$140.66
|
| Rate for Payer: Prime Health Services Commercial |
$239.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.58
|
| Rate for Payer: United Healthcare All Other HMO |
$102.77
|
| Rate for Payer: United Healthcare HMO Rider |
$100.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.14
|
|
|
HC KIT CATH CNTRL VNS 2.5FR
|
Facility
|
OP
|
$281.33
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$239.13 |
| Rate for Payer: Adventist Health Commercial |
$56.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.95
|
| Rate for Payer: Blue Shield of California Commercial |
$207.62
|
| Rate for Payer: Blue Shield of California EPN |
$136.73
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna of CA HMO |
$196.93
|
| Rate for Payer: Cigna of CA PPO |
$196.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.53
|
| Rate for Payer: EPIC Health Plan Senior |
$112.53
|
| Rate for Payer: Galaxy Health WC |
$239.13
|
| Rate for Payer: Global Benefits Group Commercial |
$168.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.93
|
| Rate for Payer: Multiplan Commercial |
$225.06
|
| Rate for Payer: Networks By Design Commercial |
$140.66
|
| Rate for Payer: Prime Health Services Commercial |
$239.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.58
|
| Rate for Payer: United Healthcare All Other HMO |
$102.77
|
| Rate for Payer: United Healthcare HMO Rider |
$100.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.13
|
| Rate for Payer: Vantage Medical Group Senior |
$239.13
|
|
|
HC KIT CATH CNTRL VNS 3FR SL
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.25
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$183.68
|
| Rate for Payer: Cigna of CA PPO |
$212.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.50
|
| Rate for Payer: United Healthcare All Other HMO |
$143.50
|
| Rate for Payer: United Healthcare HMO Rider |
$143.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC KIT CATH CNTRL VNS 3FR SL
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
|
|
HC KIT CATH CNTRL VNS 4FR DL
|
Facility
|
IP
|
$841.57
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.31 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$168.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$378.71
|
| Rate for Payer: Cash Price |
$378.71
|
| Rate for Payer: Cigna of CA HMO |
$589.10
|
| Rate for Payer: Cigna of CA PPO |
$589.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.63
|
| Rate for Payer: EPIC Health Plan Senior |
$336.63
|
| Rate for Payer: Galaxy Health WC |
$715.33
|
| Rate for Payer: Global Benefits Group Commercial |
$504.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$561.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$520.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.98
|
| Rate for Payer: Multiplan Commercial |
$673.26
|
| Rate for Payer: Networks By Design Commercial |
$420.79
|
| Rate for Payer: Prime Health Services Commercial |
$715.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$315.84
|
| Rate for Payer: United Healthcare All Other HMO |
$307.43
|
| Rate for Payer: United Healthcare HMO Rider |
$300.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.61
|
|
|
HC KIT CATH CNTRL VNS 4FR DL
|
Facility
|
IP
|
$851.28
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.26 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$170.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$383.08
|
| Rate for Payer: Cash Price |
$383.08
|
| Rate for Payer: Cigna of CA HMO |
$595.90
|
| Rate for Payer: Cigna of CA PPO |
$595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.51
|
| Rate for Payer: EPIC Health Plan Senior |
$340.51
|
| Rate for Payer: Galaxy Health WC |
$723.59
|
| Rate for Payer: Global Benefits Group Commercial |
$510.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.31
|
| Rate for Payer: Multiplan Commercial |
$681.02
|
| Rate for Payer: Networks By Design Commercial |
$425.64
|
| Rate for Payer: Prime Health Services Commercial |
$723.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.49
|
| Rate for Payer: United Healthcare All Other HMO |
$310.97
|
| Rate for Payer: United Healthcare HMO Rider |
$304.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.79
|
|
|
HC KIT CATH CNTRL VNS 4FR DL
|
Facility
|
OP
|
$841.57
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.31 |
| Max. Negotiated Rate |
$715.33 |
| Rate for Payer: Adventist Health Commercial |
$168.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$715.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$462.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$631.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$487.44
|
| Rate for Payer: Blue Shield of California Commercial |
$621.08
|
| Rate for Payer: Blue Shield of California EPN |
$409.00
|
| Rate for Payer: Cash Price |
$378.71
|
| Rate for Payer: Cigna of CA HMO |
$589.10
|
| Rate for Payer: Cigna of CA PPO |
$589.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$715.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$715.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$715.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.63
|
| Rate for Payer: EPIC Health Plan Senior |
$336.63
|
| Rate for Payer: Galaxy Health WC |
$715.33
|
| Rate for Payer: Global Benefits Group Commercial |
$504.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$561.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$520.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$589.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$589.10
|
| Rate for Payer: Multiplan Commercial |
$673.26
|
| Rate for Payer: Networks By Design Commercial |
$420.79
|
| Rate for Payer: Prime Health Services Commercial |
$715.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$504.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$315.84
|
| Rate for Payer: United Healthcare All Other HMO |
$307.43
|
| Rate for Payer: United Healthcare HMO Rider |
$300.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$715.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$715.33
|
| Rate for Payer: Vantage Medical Group Senior |
$715.33
|
|
|
HC KIT CATH CNTRL VNS 4FR DL
|
Facility
|
OP
|
$851.28
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.26 |
| Max. Negotiated Rate |
$723.59 |
| Rate for Payer: Adventist Health Commercial |
$170.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$723.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$468.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$638.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$493.06
|
| Rate for Payer: Blue Shield of California Commercial |
$628.24
|
| Rate for Payer: Blue Shield of California EPN |
$413.72
|
| Rate for Payer: Cash Price |
$383.08
|
| Rate for Payer: Cigna of CA HMO |
$595.90
|
| Rate for Payer: Cigna of CA PPO |
$595.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$723.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$723.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$723.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.51
|
| Rate for Payer: EPIC Health Plan Senior |
$340.51
|
| Rate for Payer: Galaxy Health WC |
$723.59
|
| Rate for Payer: Global Benefits Group Commercial |
$510.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.90
|
| Rate for Payer: Multiplan Commercial |
$681.02
|
| Rate for Payer: Networks By Design Commercial |
$425.64
|
| Rate for Payer: Prime Health Services Commercial |
$723.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.49
|
| Rate for Payer: United Healthcare All Other HMO |
$310.97
|
| Rate for Payer: United Healthcare HMO Rider |
$304.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$723.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$723.59
|
| Rate for Payer: Vantage Medical Group Senior |
$723.59
|
|
|
HC KIT CATH CNTRL VNS 5FR DL
|
Facility
|
OP
|
$722.06
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.41 |
| Max. Negotiated Rate |
$613.75 |
| Rate for Payer: Adventist Health Commercial |
$144.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$613.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$397.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.22
|
| Rate for Payer: Blue Shield of California Commercial |
$532.88
|
| Rate for Payer: Blue Shield of California EPN |
$350.92
|
| Rate for Payer: Cash Price |
$324.93
|
| Rate for Payer: Cigna of CA HMO |
$505.44
|
| Rate for Payer: Cigna of CA PPO |
$505.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$613.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$613.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$613.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.82
|
| Rate for Payer: EPIC Health Plan Senior |
$288.82
|
| Rate for Payer: Galaxy Health WC |
$613.75
|
| Rate for Payer: Global Benefits Group Commercial |
$433.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$481.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$446.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.44
|
| Rate for Payer: Multiplan Commercial |
$577.65
|
| Rate for Payer: Networks By Design Commercial |
$361.03
|
| Rate for Payer: Prime Health Services Commercial |
$613.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$433.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$433.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.99
|
| Rate for Payer: United Healthcare All Other HMO |
$263.77
|
| Rate for Payer: United Healthcare HMO Rider |
$258.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$236.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$613.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$613.75
|
| Rate for Payer: Vantage Medical Group Senior |
$613.75
|
|
|
HC KIT CATH CNTRL VNS 5FR DL
|
Facility
|
IP
|
$722.06
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.41 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$144.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$324.93
|
| Rate for Payer: Cash Price |
$324.93
|
| Rate for Payer: Cigna of CA HMO |
$505.44
|
| Rate for Payer: Cigna of CA PPO |
$505.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.82
|
| Rate for Payer: EPIC Health Plan Senior |
$288.82
|
| Rate for Payer: Galaxy Health WC |
$613.75
|
| Rate for Payer: Global Benefits Group Commercial |
$433.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$481.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$446.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.29
|
| Rate for Payer: Multiplan Commercial |
$577.65
|
| Rate for Payer: Networks By Design Commercial |
$361.03
|
| Rate for Payer: Prime Health Services Commercial |
$613.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.99
|
| Rate for Payer: United Healthcare All Other HMO |
$263.77
|
| Rate for Payer: United Healthcare HMO Rider |
$258.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$236.47
|
|
|
HC KIT CATH CNTRL VNS 5FR TL
|
Facility
|
IP
|
$863.47
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.69 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$172.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$388.56
|
| Rate for Payer: Cash Price |
$388.56
|
| Rate for Payer: Cigna of CA HMO |
$604.43
|
| Rate for Payer: Cigna of CA PPO |
$604.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.39
|
| Rate for Payer: EPIC Health Plan Senior |
$345.39
|
| Rate for Payer: Galaxy Health WC |
$733.95
|
| Rate for Payer: Global Benefits Group Commercial |
$518.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$575.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.23
|
| Rate for Payer: Multiplan Commercial |
$690.78
|
| Rate for Payer: Networks By Design Commercial |
$431.74
|
| Rate for Payer: Prime Health Services Commercial |
$733.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.06
|
| Rate for Payer: United Healthcare All Other HMO |
$315.43
|
| Rate for Payer: United Healthcare HMO Rider |
$308.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.79
|
|
|
HC KIT CATH CNTRL VNS 5FR TL
|
Facility
|
OP
|
$863.47
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.69 |
| Max. Negotiated Rate |
$733.95 |
| Rate for Payer: Adventist Health Commercial |
$172.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$733.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$474.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.12
|
| Rate for Payer: Blue Shield of California Commercial |
$637.24
|
| Rate for Payer: Blue Shield of California EPN |
$419.65
|
| Rate for Payer: Cash Price |
$388.56
|
| Rate for Payer: Cigna of CA HMO |
$604.43
|
| Rate for Payer: Cigna of CA PPO |
$604.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$733.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$733.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$733.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.39
|
| Rate for Payer: EPIC Health Plan Senior |
$345.39
|
| Rate for Payer: Galaxy Health WC |
$733.95
|
| Rate for Payer: Global Benefits Group Commercial |
$518.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$575.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$604.43
|
| Rate for Payer: Multiplan Commercial |
$690.78
|
| Rate for Payer: Networks By Design Commercial |
$431.74
|
| Rate for Payer: Prime Health Services Commercial |
$733.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.06
|
| Rate for Payer: United Healthcare All Other HMO |
$315.43
|
| Rate for Payer: United Healthcare HMO Rider |
$308.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$733.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$733.95
|
| Rate for Payer: Vantage Medical Group Senior |
$733.95
|
|
|
HC KIT CATH CNTRL VNS 5FR TL
|
Facility
|
OP
|
$863.47
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.69 |
| Max. Negotiated Rate |
$733.95 |
| Rate for Payer: Adventist Health Commercial |
$172.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$733.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$474.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.12
|
| Rate for Payer: Blue Shield of California Commercial |
$637.24
|
| Rate for Payer: Blue Shield of California EPN |
$419.65
|
| Rate for Payer: Cash Price |
$388.56
|
| Rate for Payer: Cigna of CA HMO |
$604.43
|
| Rate for Payer: Cigna of CA PPO |
$604.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$733.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$733.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$733.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.39
|
| Rate for Payer: EPIC Health Plan Senior |
$345.39
|
| Rate for Payer: Galaxy Health WC |
$733.95
|
| Rate for Payer: Global Benefits Group Commercial |
$518.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$575.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$604.43
|
| Rate for Payer: Multiplan Commercial |
$690.78
|
| Rate for Payer: Networks By Design Commercial |
$431.74
|
| Rate for Payer: Prime Health Services Commercial |
$733.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.06
|
| Rate for Payer: United Healthcare All Other HMO |
$315.43
|
| Rate for Payer: United Healthcare HMO Rider |
$308.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$733.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$733.95
|
| Rate for Payer: Vantage Medical Group Senior |
$733.95
|
|
