|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
OP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
905355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,347.44 |
| Max. Negotiated Rate |
$8,313.85 |
| Rate for Payer: Adventist Health Commercial |
$4,010.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,379.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,920.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,521.59
|
| Rate for Payer: Blue Shield of California Commercial |
$4,958.97
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,313.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,313.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,400.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,210.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,714.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,770.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,846.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,846.70
|
| Rate for Payer: Multiplan Commercial |
$7,824.80
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,868.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,868.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,313.85
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
OP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
915355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,347.44 |
| Max. Negotiated Rate |
$8,313.85 |
| Rate for Payer: Adventist Health Commercial |
$4,010.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,379.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,920.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,521.59
|
| Rate for Payer: Blue Shield of California Commercial |
$4,958.97
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,313.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,313.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,400.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,210.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,714.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,770.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,846.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,846.70
|
| Rate for Payer: Multiplan Commercial |
$7,824.80
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,868.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,868.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,313.85
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
IP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
905355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,956.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,956.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,210.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,770.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.44
|
| Rate for Payer: Multiplan Commercial |
$7,824.80
|
| Rate for Payer: Networks By Design Commercial |
$6,357.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
IP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
915355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,956.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,956.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,210.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,770.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.44
|
| Rate for Payer: Multiplan Commercial |
$7,824.80
|
| Rate for Payer: Networks By Design Commercial |
$6,357.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
|
|
HC KD MOLD SKT SACH ENDO SFT COVR
|
Facility
|
IP
|
$15,373.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,074.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3,074.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,917.85
|
| Rate for Payer: Cash Price |
$6,917.85
|
| Rate for Payer: Cigna of CA HMO |
$10,761.10
|
| Rate for Payer: Cigna of CA PPO |
$10,761.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,761.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,149.20
|
| Rate for Payer: Galaxy Health WC |
$13,067.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,223.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,761.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,070.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,689.52
|
| Rate for Payer: Multiplan Commercial |
$12,298.40
|
| Rate for Payer: Networks By Design Commercial |
$9,992.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,067.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,769.49
|
| Rate for Payer: United Healthcare All Other HMO |
$5,615.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5,494.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,034.66
|
|
|
HC KD MOLD SKT SACH ENDO SFT COVR
|
Facility
|
OP
|
$15,373.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,689.52 |
| Max. Negotiated Rate |
$13,067.05 |
| Rate for Payer: Adventist Health Commercial |
$6,302.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,455.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,529.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,305.28
|
| Rate for Payer: Blue Shield of California Commercial |
$11,821.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7,794.11
|
| Rate for Payer: Cash Price |
$6,917.85
|
| Rate for Payer: Cigna of CA HMO |
$10,761.10
|
| Rate for Payer: Cigna of CA PPO |
$10,761.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,067.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,067.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,761.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,149.20
|
| Rate for Payer: Galaxy Health WC |
$13,067.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,223.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,761.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,580.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,070.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,689.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,761.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,761.10
|
| Rate for Payer: Multiplan Commercial |
$12,298.40
|
| Rate for Payer: Networks By Design Commercial |
$7,686.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,067.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,223.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,223.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,769.49
|
| Rate for Payer: United Healthcare All Other HMO |
$5,615.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5,494.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,034.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,067.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13,067.05
|
|
|
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 |
$746.94
|
| Rate for Payer: Blue Shield of California Commercial |
$948.95
|
| Rate for Payer: Blue Shield of California Commercial |
$625.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$783.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$728.06
|
| 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 |
915355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$783.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$728.06
|
| 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 |
$802.10
|
| 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 |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$783.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$728.06
|
| 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 |
$802.10
|
| 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
|
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 |
$746.94
|
| Rate for Payer: Blue Shield of California Commercial |
$948.95
|
| Rate for Payer: Blue Shield of California Commercial |
$625.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$783.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$728.06
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,087.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$986.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$916.27
|
| 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 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 |
$604.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.56
|
| Rate for Payer: Blue Shield of California Commercial |
$990.81
|
| Rate for Payer: Blue Shield of California Commercial |
$653.81
|
| 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 |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,087.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| 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/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$986.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| 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 |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
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 |
$1,356.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,556.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,547.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,021.35
|
| 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 |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,698.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| 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/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,540.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| 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 |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,698.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,540.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,431.34
|
| 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 |
$125.01
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.37
|
| 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 Foundation Hospitals Commercial/Self Funded |
$123.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.94
|
| 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: 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: Adventist Health Commercial |
$38.96
|
| Rate for Payer: Cash Price |
$87.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.37
|
| Rate for Payer: Global Benefits Group Commercial |
$116.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.69
|
| 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 Foundation Hospitals Commercial/Self Funded |
$54.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.31
|
| 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 |
$54.72
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.69
|
| 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 Foundation Hospitals Commercial/Self Funded |
$54.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.31
|
| 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
|
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 |
$170.29
|
| Rate for Payer: Blue Shield of California Commercial |
$142.63
|
| Rate for Payer: Blue Shield of California Commercial |
$216.34
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$178.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.98
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$56.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$178.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.98
|
| 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 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: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
|
|
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 |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.59
|
| 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 |
$184.17
|
| Rate for Payer: Cash Price |
$129.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| 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 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 |
$515.28
|
| Rate for Payer: Blue Shield of California Commercial |
$431.60
|
| Rate for Payer: Blue Shield of California Commercial |
$654.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$540.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$502.26
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$168.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$534.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$496.53
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$170.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$540.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$502.26
|
| 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
|
|
