|
HC KIT DRSNG ASPIRA
|
Facility
|
IP
|
$153.72
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901606874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$130.66 |
| Rate for Payer: Adventist Health Commercial |
$30.74
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.49
|
| Rate for Payer: EPIC Health Plan Senior |
$61.49
|
| Rate for Payer: Galaxy Health WC |
$130.66
|
| Rate for Payer: Global Benefits Group Commercial |
$92.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.89
|
| Rate for Payer: Multiplan Commercial |
$122.98
|
| Rate for Payer: Networks By Design Commercial |
$99.92
|
| Rate for Payer: Prime Health Services Commercial |
$130.66
|
|
|
HC KIT DRSNG CHANGE PICC CVC
|
Facility
|
OP
|
$280.21
|
|
| Hospital Charge Code |
901698163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.04 |
| Max. Negotiated Rate |
$238.18 |
| Rate for Payer: Adventist Health Commercial |
$56.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.08
|
| Rate for Payer: Cash Price |
$154.12
|
| Rate for Payer: Cigna of CA HMO |
$179.33
|
| Rate for Payer: Cigna of CA PPO |
$207.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.08
|
| Rate for Payer: EPIC Health Plan Senior |
$112.08
|
| Rate for Payer: Galaxy Health WC |
$238.18
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.15
|
| Rate for Payer: Multiplan Commercial |
$224.17
|
| Rate for Payer: Networks By Design Commercial |
$182.14
|
| Rate for Payer: Prime Health Services Commercial |
$238.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.10
|
| Rate for Payer: United Healthcare All Other HMO |
$140.10
|
| Rate for Payer: United Healthcare HMO Rider |
$140.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.18
|
| Rate for Payer: Vantage Medical Group Senior |
$238.18
|
|
|
HC KIT DRSNG CHANGE PICC CVC
|
Facility
|
IP
|
$280.21
|
|
| Hospital Charge Code |
901698163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.04 |
| Max. Negotiated Rate |
$238.18 |
| Rate for Payer: Adventist Health Commercial |
$56.04
|
| Rate for Payer: Cash Price |
$154.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.08
|
| Rate for Payer: EPIC Health Plan Senior |
$112.08
|
| Rate for Payer: Galaxy Health WC |
$238.18
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Multiplan Commercial |
$224.17
|
| Rate for Payer: Networks By Design Commercial |
$182.14
|
| Rate for Payer: Prime Health Services Commercial |
$238.18
|
|
|
HC KIT IAP MONITOR
|
Facility
|
OP
|
$509.65
|
|
| Hospital Charge Code |
901605588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.93 |
| Max. Negotiated Rate |
$433.20 |
| Rate for Payer: Adventist Health Commercial |
$101.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$334.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$433.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$280.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$382.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.98
|
| Rate for Payer: Cash Price |
$280.31
|
| Rate for Payer: Cigna of CA HMO |
$326.18
|
| Rate for Payer: Cigna of CA PPO |
$377.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$433.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$433.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$433.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.86
|
| Rate for Payer: EPIC Health Plan Senior |
$203.86
|
| Rate for Payer: Galaxy Health WC |
$433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$305.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.75
|
| Rate for Payer: Multiplan Commercial |
$407.72
|
| Rate for Payer: Networks By Design Commercial |
$331.27
|
| Rate for Payer: Prime Health Services Commercial |
$433.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.82
|
| Rate for Payer: United Healthcare All Other HMO |
$254.82
|
| Rate for Payer: United Healthcare HMO Rider |
$254.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$433.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$433.20
|
| Rate for Payer: Vantage Medical Group Senior |
$433.20
|
|
|
HC KIT IAP MONITOR
|
Facility
|
IP
|
$509.65
|
|
| Hospital Charge Code |
901605588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.93 |
| Max. Negotiated Rate |
$433.20 |
| Rate for Payer: Adventist Health Commercial |
$101.93
|
| Rate for Payer: Cash Price |
$280.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.86
|
| Rate for Payer: EPIC Health Plan Senior |
$203.86
|
| Rate for Payer: Galaxy Health WC |
$433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$305.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.32
|
| Rate for Payer: Multiplan Commercial |
$407.72
|
| Rate for Payer: Networks By Design Commercial |
$331.27
|
| Rate for Payer: Prime Health Services Commercial |
$433.20
|
|
|
HC KIT INDR 3.5FR .018IN X 40CM
|
Facility
|
OP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$257.63 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$198.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.13
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Cigna of CA HMO |
$193.98
|
| Rate for Payer: Cigna of CA PPO |
$224.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.17
|
| Rate for Payer: Multiplan Commercial |
$242.48
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.55
|
| Rate for Payer: United Healthcare All Other HMO |
$151.55
|
| Rate for Payer: United Healthcare HMO Rider |
$151.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.63
|
| Rate for Payer: Vantage Medical Group Senior |
$257.63
|
|
|
HC KIT INDR 3.5FR .018IN X 40CM
|
Facility
|
IP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$257.63 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.74
|
| Rate for Payer: Multiplan Commercial |
$242.48
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 4FR .018IN DIA X 40CM
|
Facility
|
OP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$257.63 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$198.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.13
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Cigna of CA HMO |
$193.98
|
| Rate for Payer: Cigna of CA PPO |
$224.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.17
|
| Rate for Payer: Multiplan Commercial |
$242.48
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.55
|
| Rate for Payer: United Healthcare All Other HMO |
$151.55
|
| Rate for Payer: United Healthcare HMO Rider |
$151.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.63
|
| Rate for Payer: Vantage Medical Group Senior |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 4FR .018IN DIA X 40CM
|
Facility
|
IP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$257.63 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.74
|
| Rate for Payer: Multiplan Commercial |
$242.48
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 5FR .018IN DIA X 40CM
|
Facility
|
IP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$257.63 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.74
|
| Rate for Payer: Multiplan Commercial |
$242.48
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 5FR .018IN DIA X 40CM
|
Facility
|
OP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$257.63 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$198.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.13
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Cigna of CA HMO |
$193.98
|
| Rate for Payer: Cigna of CA PPO |
$224.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.17
|
| Rate for Payer: Multiplan Commercial |
$242.48
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.55
|
| Rate for Payer: United Healthcare All Other HMO |
$151.55
|
| Rate for Payer: United Healthcare HMO Rider |
$151.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.63
|
| Rate for Payer: Vantage Medical Group Senior |
$257.63
|
|
|
HC KIT INTRODUCER SHEATH 8.5FR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC KIT INTRODUCER SHEATH 8.5FR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC KIT PORT DRSNG CHG
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901698218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.34
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC KIT PORT DRSNG CHG
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901698218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC KIT RESUSCITATION MURRIETA
|
Facility
|
IP
|
$255.64
|
|
| Hospital Charge Code |
901698319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$217.29 |
| Rate for Payer: Adventist Health Commercial |
$51.13
|
| Rate for Payer: Cash Price |
$140.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.26
|
| Rate for Payer: EPIC Health Plan Senior |
$102.26
|
| Rate for Payer: Galaxy Health WC |
$217.29
|
| Rate for Payer: Global Benefits Group Commercial |
$153.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.35
|
| Rate for Payer: Multiplan Commercial |
$204.51
|
| Rate for Payer: Networks By Design Commercial |
$166.17
|
| Rate for Payer: Prime Health Services Commercial |
$217.29
|
|
|
HC KIT RESUSCITATION MURRIETA
|
Facility
|
OP
|
$255.64
|
|
| Hospital Charge Code |
901698319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$217.29 |
| Rate for Payer: Adventist Health Commercial |
$51.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.99
|
| Rate for Payer: Cash Price |
$140.60
|
| Rate for Payer: Cigna of CA HMO |
$163.61
|
| Rate for Payer: Cigna of CA PPO |
$189.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.26
|
| Rate for Payer: EPIC Health Plan Senior |
$102.26
|
| Rate for Payer: Galaxy Health WC |
$217.29
|
| Rate for Payer: Global Benefits Group Commercial |
$153.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.95
|
| Rate for Payer: Multiplan Commercial |
$204.51
|
| Rate for Payer: Networks By Design Commercial |
$166.17
|
| Rate for Payer: Prime Health Services Commercial |
$217.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.82
|
| Rate for Payer: United Healthcare All Other HMO |
$127.82
|
| Rate for Payer: United Healthcare HMO Rider |
$127.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$217.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.29
|
| Rate for Payer: Vantage Medical Group Senior |
$217.29
|
|
|
HC KIT SPECI CATH FEMALE 8FR PVP
|
Facility
|
OP
|
$13.04
|
|
| Hospital Charge Code |
901607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.01
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Cigna of CA HMO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
HC KIT SPECI CATH FEMALE 8FR PVP
|
Facility
|
IP
|
$13.04
|
|
| Hospital Charge Code |
901607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
HC KIT URINEMETER 200ML
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901603336
|
|
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 KIT URINEMETER 200ML
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901603336
|
|
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: 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: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC KNEE 1-2 VIEWS
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$248.00
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
|
|
HC KNEE 1-2 VIEWS
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$406.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.49
|
| Rate for Payer: Blue Shield of California Commercial |
$379.44
|
| Rate for Payer: Blue Shield of California EPN |
$250.48
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna of CA HMO |
$396.80
|
| Rate for Payer: Cigna of CA PPO |
$458.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
IP
|
$713.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$606.05 |
| Rate for Payer: Adventist Health Commercial |
$142.60
|
| Rate for Payer: Cash Price |
$392.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.20
|
| Rate for Payer: EPIC Health Plan Senior |
$285.20
|
| Rate for Payer: Galaxy Health WC |
$606.05
|
| Rate for Payer: Global Benefits Group Commercial |
$427.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$475.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$441.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$570.40
|
| Rate for Payer: Networks By Design Commercial |
$463.45
|
| Rate for Payer: Prime Health Services Commercial |
$606.05
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
OP
|
$713.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$606.05 |
| Rate for Payer: Adventist Health Commercial |
$142.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.12
|
| Rate for Payer: Blue Shield of California Commercial |
$436.36
|
| Rate for Payer: Blue Shield of California EPN |
$288.05
|
| Rate for Payer: Cash Price |
$392.15
|
| Rate for Payer: Cash Price |
$392.15
|
| Rate for Payer: Cigna of CA HMO |
$456.32
|
| Rate for Payer: Cigna of CA PPO |
$527.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$606.05
|
| Rate for Payer: Global Benefits Group Commercial |
$427.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$475.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$570.40
|
| Rate for Payer: Networks By Design Commercial |
$463.45
|
| Rate for Payer: Prime Health Services Commercial |
$606.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
