|
HC MIAMI JR REPLCMNT PAD 2-6YR
|
Facility
|
OP
|
$141.89
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605414
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$120.61 |
| Rate for Payer: Adventist Health Commercial |
$58.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.18
|
| Rate for Payer: Blue Shield of California Commercial |
$104.71
|
| Rate for Payer: Blue Shield of California EPN |
$68.96
|
| Rate for Payer: Cash Price |
$78.04
|
| Rate for Payer: Cigna of CA HMO |
$99.32
|
| Rate for Payer: Cigna of CA PPO |
$99.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.76
|
| Rate for Payer: EPIC Health Plan Senior |
$56.76
|
| Rate for Payer: Galaxy Health WC |
$120.61
|
| Rate for Payer: Global Benefits Group Commercial |
$85.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.32
|
| Rate for Payer: Multiplan Commercial |
$113.51
|
| Rate for Payer: Networks By Design Commercial |
$70.94
|
| Rate for Payer: Prime Health Services Commercial |
$120.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.25
|
| Rate for Payer: United Healthcare All Other HMO |
$51.83
|
| Rate for Payer: United Healthcare HMO Rider |
$50.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.61
|
| Rate for Payer: Vantage Medical Group Senior |
$120.61
|
|
|
HC MIAMI JR REPLCMNT PAD 6-12YR
|
Facility
|
OP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Adventist Health Commercial |
$39.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.24
|
| Rate for Payer: Blue Shield of California Commercial |
$70.39
|
| Rate for Payer: Blue Shield of California EPN |
$46.35
|
| Rate for Payer: Cash Price |
$52.46
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.77
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other HMO |
$34.84
|
| Rate for Payer: United Healthcare HMO Rider |
$34.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.07
|
| Rate for Payer: Vantage Medical Group Senior |
$81.07
|
|
|
HC MIAMI JR REPLCMNT PAD 6-12YR
|
Facility
|
IP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$52.46
|
| Rate for Payer: Cash Price |
$52.46
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other HMO |
$34.84
|
| Rate for Payer: United Healthcare HMO Rider |
$34.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
|
|
HC MIAMI JR REPLCMNT PAD 6MO-2YR
|
Facility
|
IP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605413
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$52.46
|
| Rate for Payer: Cash Price |
$52.46
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other HMO |
$34.84
|
| Rate for Payer: United Healthcare HMO Rider |
$34.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
|
|
HC MIAMI JR REPLCMNT PAD 6MO-2YR
|
Facility
|
OP
|
$95.38
|
|
|
Service Code
|
CPT L9900
|
| Hospital Charge Code |
901605413
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Adventist Health Commercial |
$39.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.24
|
| Rate for Payer: Blue Shield of California Commercial |
$70.39
|
| Rate for Payer: Blue Shield of California EPN |
$46.35
|
| Rate for Payer: Cash Price |
$52.46
|
| Rate for Payer: Cigna of CA HMO |
$66.77
|
| Rate for Payer: Cigna of CA PPO |
$66.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.77
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$47.69
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other HMO |
$34.84
|
| Rate for Payer: United Healthcare HMO Rider |
$34.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.07
|
| Rate for Payer: Vantage Medical Group Senior |
$81.07
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.01
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.00
|
| Rate for Payer: United Healthcare All Other HMO |
$114.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
IP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$287.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.60
|
| Rate for Payer: Blue Shield of California Commercial |
$518.08
|
| Rate for Payer: Blue Shield of California EPN |
$341.17
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cigna of CA HMO |
$491.40
|
| Rate for Payer: Cigna of CA PPO |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.46
|
| Rate for Payer: United Healthcare All Other HMO |
$256.44
|
| Rate for Payer: United Healthcare HMO Rider |
$250.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.91
|
|
|
HC MICROALBUMIN
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC MICROALBUMIN
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.19
|
| Rate for Payer: Blue Shield of California Commercial |
$143.84
|
| Rate for Payer: Blue Shield of California EPN |
$95.03
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROCATH DIREXION
|
Facility
|
OP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.20 |
| Max. Negotiated Rate |
$2,597.60 |
| Rate for Payer: Adventist Health Commercial |
$611.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,004.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,292.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,876.69
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cigna of CA HMO |
$1,955.84
|
| Rate for Payer: Cigna of CA PPO |
$2,261.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,597.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,597.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,222.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,222.40
|
| Rate for Payer: Galaxy Health WC |
$2,597.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,833.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,038.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,891.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$733.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,139.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,139.20
|
| Rate for Payer: Multiplan Commercial |
$2,444.80
|
| Rate for Payer: Networks By Design Commercial |
$1,986.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,597.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,833.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,833.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,528.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,528.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,528.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,528.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,597.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,597.60
|
|
|
HC MICROCATH DIREXION
|
Facility
|
IP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.20 |
| Max. Negotiated Rate |
$2,597.60 |
| Rate for Payer: Adventist Health Commercial |
$611.20
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,222.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,222.40
|
| Rate for Payer: Galaxy Health WC |
$2,597.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,833.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,038.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,891.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$733.44
|
| Rate for Payer: Multiplan Commercial |
$2,444.80
|
| Rate for Payer: Networks By Design Commercial |
$1,986.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,597.60
|
|
|
HC MICROCATHETER
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$819.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$585.00
|
| Rate for Payer: United Healthcare All Other HMO |
$585.00
|
| Rate for Payer: United Healthcare HMO Rider |
$585.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$585.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC MICROCATHETER
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC MICROCATH MAGIC
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,247.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,864.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.17
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,417.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,387.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,271.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC MICROCATH MAGIC
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,417.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,387.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,271.03
|
|
|
HC MICROCATH MAGIC FLOW
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909091887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,417.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,387.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,271.03
|
|
|
HC MICROCATH MAGIC FLOW
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909091887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,247.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,864.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.17
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,417.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,387.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,271.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC MICROCATH NAVIEN
|
Facility
|
OP
|
$3,563.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.60 |
| Max. Negotiated Rate |
$3,028.55 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,959.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,672.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,063.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,629.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,731.62
|
| Rate for Payer: Cash Price |
$1,959.65
|
| Rate for Payer: Cigna of CA HMO |
$2,494.10
|
| Rate for Payer: Cigna of CA PPO |
$2,494.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,028.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,028.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,425.20
|
| Rate for Payer: Galaxy Health WC |
$3,028.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,376.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,205.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,494.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,494.10
|
| Rate for Payer: Multiplan Commercial |
$2,850.40
|
| Rate for Payer: Networks By Design Commercial |
$1,781.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,028.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,137.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,137.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,337.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,301.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1,273.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,166.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,028.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,028.55
|
|
|
HC MICROCATH NAVIEN
|
Facility
|
IP
|
$3,563.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,959.65
|
| Rate for Payer: Cash Price |
$1,959.65
|
| Rate for Payer: Cigna of CA HMO |
$2,494.10
|
| Rate for Payer: Cigna of CA PPO |
$2,494.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,425.20
|
| Rate for Payer: Galaxy Health WC |
$3,028.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,376.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,205.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.12
|
| Rate for Payer: Multiplan Commercial |
$2,850.40
|
| Rate for Payer: Networks By Design Commercial |
$1,781.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,028.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,337.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,301.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1,273.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,166.88
|
|
|
HC MICROCATH ORION
|
Facility
|
OP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.20 |
| Max. Negotiated Rate |
$3,957.60 |
| Rate for Payer: Cigna of CA HMO |
$2,979.84
|
| Rate for Payer: Adventist Health Commercial |
$931.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,053.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,560.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,492.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,859.25
|
| Rate for Payer: Cash Price |
$2,560.80
|
| Rate for Payer: Cigna of CA PPO |
$3,445.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,957.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.40
|
| Rate for Payer: Galaxy Health WC |
$3,957.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,793.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,105.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,773.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,259.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,259.20
|
| Rate for Payer: Multiplan Commercial |
$3,724.80
|
| Rate for Payer: Networks By Design Commercial |
$3,026.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,957.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,793.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,793.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,957.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,957.60
|
|
|
HC MICROCATH ORION
|
Facility
|
IP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.20 |
| Max. Negotiated Rate |
$3,957.60 |
| Rate for Payer: Adventist Health Commercial |
$931.20
|
| Rate for Payer: Cash Price |
$2,560.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.40
|
| Rate for Payer: Galaxy Health WC |
$3,957.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,793.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,105.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,773.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.44
|
| Rate for Payer: Multiplan Commercial |
$3,724.80
|
| Rate for Payer: Networks By Design Commercial |
$3,026.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,957.60
|
|
|
HC MICRO CATH, PENUMBRA
|
Facility
|
OP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$3,082.95 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,378.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,994.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,720.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,227.34
|
| Rate for Payer: Cash Price |
$1,994.85
|
| Rate for Payer: Cigna of CA HMO |
$2,321.28
|
| Rate for Payer: Cigna of CA PPO |
$2,683.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,082.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,082.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.80
|
| Rate for Payer: Galaxy Health WC |
$3,082.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,245.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,538.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,538.90
|
| Rate for Payer: Multiplan Commercial |
$2,901.60
|
| Rate for Payer: Networks By Design Commercial |
$2,357.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,176.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,813.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,813.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,813.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,082.95
|
|
|
HC MICRO CATH, PENUMBRA
|
Facility
|
IP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$3,082.95 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Cash Price |
$1,994.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.80
|
| Rate for Payer: Galaxy Health WC |
$3,082.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,245.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.48
|
| Rate for Payer: Multiplan Commercial |
$2,901.60
|
| Rate for Payer: Networks By Design Commercial |
$2,357.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.95
|
|
