|
HC KIT CATH PEDIATRIC 8FR PVP
|
Facility
|
OP
|
$15.42
|
|
|
Service Code
|
CPT A4311
|
| Hospital Charge Code |
901607342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$42.34 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.90
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cigna of CA HMO |
$9.87
|
| Rate for Payer: Cigna of CA PPO |
$11.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.17
|
| Rate for Payer: Galaxy Health WC |
$13.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$12.34
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.71
|
| Rate for Payer: United Healthcare All Other HMO |
$7.71
|
| Rate for Payer: United Healthcare HMO Rider |
$7.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.11
|
|
|
HC KIT CATH U-BND 2LUM 12FRX16CM
|
Facility
|
OP
|
$692.71
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.54 |
| Max. Negotiated Rate |
$588.80 |
| Rate for Payer: Adventist Health Commercial |
$138.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$380.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$519.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$419.30
|
| Rate for Payer: Blue Shield of California Commercial |
$351.20
|
| Rate for Payer: Blue Shield of California Commercial |
$532.69
|
| Rate for Payer: Cash Price |
$311.72
|
| Rate for Payer: Cigna of CA HMO |
$484.90
|
| Rate for Payer: Cigna of CA PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$588.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$588.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$484.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.08
|
| Rate for Payer: EPIC Health Plan Senior |
$277.08
|
| Rate for Payer: Galaxy Health WC |
$588.80
|
| Rate for Payer: Global Benefits Group Commercial |
$415.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$439.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$408.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$484.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$484.90
|
| Rate for Payer: Multiplan Commercial |
$554.17
|
| Rate for Payer: Networks By Design Commercial |
$346.36
|
| Rate for Payer: Prime Health Services Commercial |
$588.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$415.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$415.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.97
|
| Rate for Payer: United Healthcare All Other HMO |
$253.05
|
| Rate for Payer: United Healthcare HMO Rider |
$247.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$588.80
|
| Rate for Payer: Vantage Medical Group Senior |
$588.80
|
|
|
HC KIT CATH U-BND 2LUM 12FRX16CM
|
Facility
|
IP
|
$692.71
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.54 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$138.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$311.72
|
| Rate for Payer: Cash Price |
$311.72
|
| Rate for Payer: Cigna of CA HMO |
$484.90
|
| Rate for Payer: Cigna of CA PPO |
$484.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$484.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.08
|
| Rate for Payer: EPIC Health Plan Senior |
$277.08
|
| Rate for Payer: Galaxy Health WC |
$588.80
|
| Rate for Payer: Global Benefits Group Commercial |
$415.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$439.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$408.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| Rate for Payer: Multiplan Commercial |
$554.17
|
| Rate for Payer: Networks By Design Commercial |
$346.36
|
| Rate for Payer: Prime Health Services Commercial |
$588.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.97
|
| Rate for Payer: United Healthcare All Other HMO |
$253.05
|
| Rate for Payer: United Healthcare HMO Rider |
$247.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.86
|
|
|
HC KIT CATH U-BND 2LUM 12FRX20CM
|
Facility
|
OP
|
$655.04
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.01 |
| Max. Negotiated Rate |
$556.78 |
| Rate for Payer: Adventist Health Commercial |
$131.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$556.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$360.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$396.50
|
| Rate for Payer: Blue Shield of California Commercial |
$332.11
|
| Rate for Payer: Blue Shield of California Commercial |
$503.73
|
| Rate for Payer: Cash Price |
$294.77
|
| Rate for Payer: Cigna of CA HMO |
$458.53
|
| Rate for Payer: Cigna of CA PPO |
$458.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$556.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$556.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$556.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$458.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.02
|
| Rate for Payer: EPIC Health Plan Senior |
$262.02
|
| Rate for Payer: Galaxy Health WC |
$556.78
|
| Rate for Payer: Global Benefits Group Commercial |
$393.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.53
|
| Rate for Payer: Multiplan Commercial |
$524.03
|
| Rate for Payer: Networks By Design Commercial |
$327.52
|
| Rate for Payer: Prime Health Services Commercial |
$556.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$393.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.84
|
| Rate for Payer: United Healthcare All Other HMO |
$239.29
|
| Rate for Payer: United Healthcare HMO Rider |
$234.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$556.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$556.78
|
| Rate for Payer: Vantage Medical Group Senior |
$556.78
|
|
|
HC KIT CATH U-BND 2LUM 12FRX20CM
|
Facility
|
IP
|
$655.04
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.01 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$131.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$294.77
|
| Rate for Payer: Cash Price |
$294.77
|
| Rate for Payer: Cigna of CA HMO |
$458.53
|
| Rate for Payer: Cigna of CA PPO |
$458.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$458.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.02
|
| Rate for Payer: EPIC Health Plan Senior |
$262.02
|
| Rate for Payer: Galaxy Health WC |
$556.78
|
| Rate for Payer: Global Benefits Group Commercial |
$393.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.21
|
| Rate for Payer: Multiplan Commercial |
$524.03
|
| Rate for Payer: Networks By Design Commercial |
$327.52
|
| Rate for Payer: Prime Health Services Commercial |
$556.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.84
|
| Rate for Payer: United Healthcare All Other HMO |
$239.29
|
| Rate for Payer: United Healthcare HMO Rider |
$234.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.53
|
|
|
HC KIT CENTRAL VENOUS 4 LUMEN 8.5 FR,POWER INJ
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.07
|
| Rate for Payer: Blue Shield of California Commercial |
$294.06
|
| Rate for Payer: Blue Shield of California Commercial |
$446.02
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC KIT CENTRAL VENOUS 4 LUMEN 8.5 FR,POWER INJ
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC KIT CENTRAL VENOUS CATHETER MAC 9FR DL W/CURVED SUTURE NEEDLE
|
Facility
|
OP
|
$613.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.67 |
| Max. Negotiated Rate |
$521.36 |
| Rate for Payer: Adventist Health Commercial |
$122.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$460.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.27
|
| Rate for Payer: Blue Shield of California Commercial |
$310.97
|
| Rate for Payer: Blue Shield of California Commercial |
$471.67
|
| Rate for Payer: Cash Price |
$276.01
|
| Rate for Payer: Cigna of CA HMO |
$429.35
|
| Rate for Payer: Cigna of CA PPO |
$429.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.34
|
| Rate for Payer: EPIC Health Plan Senior |
$245.34
|
| Rate for Payer: Galaxy Health WC |
$521.36
|
| Rate for Payer: Global Benefits Group Commercial |
$368.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$429.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$429.35
|
| Rate for Payer: Multiplan Commercial |
$490.69
|
| Rate for Payer: Networks By Design Commercial |
$306.68
|
| Rate for Payer: Prime Health Services Commercial |
$521.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$368.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.19
|
| Rate for Payer: United Healthcare All Other HMO |
$224.06
|
| Rate for Payer: United Healthcare HMO Rider |
$219.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.36
|
| Rate for Payer: Vantage Medical Group Senior |
$521.36
|
|
|
HC KIT CENTRAL VENOUS CATHETER MAC 9FR DL W/CURVED SUTURE NEEDLE
|
Facility
|
IP
|
$613.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.67 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$122.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$276.01
|
| Rate for Payer: Cash Price |
$276.01
|
| Rate for Payer: Cigna of CA HMO |
$429.35
|
| Rate for Payer: Cigna of CA PPO |
$429.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.34
|
| Rate for Payer: EPIC Health Plan Senior |
$245.34
|
| Rate for Payer: Galaxy Health WC |
$521.36
|
| Rate for Payer: Global Benefits Group Commercial |
$368.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.21
|
| Rate for Payer: Multiplan Commercial |
$490.69
|
| Rate for Payer: Networks By Design Commercial |
$306.68
|
| Rate for Payer: Prime Health Services Commercial |
$521.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.19
|
| Rate for Payer: United Healthcare All Other HMO |
$224.06
|
| Rate for Payer: United Healthcare HMO Rider |
$219.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.88
|
|
|
HC KIT CNTRL LINE CHANGE INFANT
|
Facility
|
IP
|
$85.27
|
|
| Hospital Charge Code |
901698193
|
|
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 CNTRL LINE CHANGE INFANT
|
Facility
|
OP
|
$85.27
|
|
| Hospital Charge Code |
901698193
|
|
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 CVC/PICC DRSNG CHNG, ADULT
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
901698239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC KIT CVC/PICC DRSNG CHNG, ADULT
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
901698239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.31
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20.50
|
| Rate for Payer: United Healthcare HMO Rider |
$20.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
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 |
$69.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$97.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.69
|
| 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 ASPIRA
|
Facility
|
OP
|
$153.72
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901606874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$130.66 |
| Rate for Payer: Adventist Health Commercial |
$30.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.64
|
| Rate for Payer: Cash Price |
$69.17
|
| Rate for Payer: Cash Price |
$69.17
|
| Rate for Payer: Cigna of CA HMO |
$98.38
|
| Rate for Payer: Cigna of CA PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$97.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.60
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.86
|
| Rate for Payer: United Healthcare All Other HMO |
$76.86
|
| Rate for Payer: United Healthcare HMO Rider |
$76.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.66
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
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 |
$126.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.15
|
| 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 Foundation Hospitals Commercial/Self Funded |
$177.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.32
|
| 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 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 |
$179.81
|
| Rate for Payer: Cash Price |
$126.09
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.15
|
| 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 Foundation Hospitals Commercial/Self Funded |
$177.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.32
|
| 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 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 |
$229.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$356.75
|
| 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 Foundation Hospitals Commercial/Self Funded |
$323.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.69
|
| 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 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 |
$327.04
|
| Rate for Payer: Cash Price |
$229.34
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$356.75
|
| 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 Foundation Hospitals Commercial/Self Funded |
$323.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.69
|
| 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 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 |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| 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 |
$194.50
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Cash Price |
$136.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$192.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.83
|
| 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 |
$136.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$192.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.83
|
| 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
|
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 |
$136.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$192.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.83
|
| 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 |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| 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 |
$194.50
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Cash Price |
$136.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$192.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.83
|
| 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 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 |
$136.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$192.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.83
|
| 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 |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| 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 |
$194.50
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Cash Price |
$136.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$192.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.83
|
| 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
|
|
