|
HC SENSORY INTEGRAT TECH 15 MIN MCAL
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
901300064
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.61 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$120.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$192.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna of CA HMO |
$188.16
|
| Rate for Payer: Cigna of CA PPO |
$217.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC SENSORY INTEGRAT TECH 15 MIN MCAL
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
900400062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.61 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$120.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$192.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna of CA HMO |
$188.16
|
| Rate for Payer: Cigna of CA PPO |
$217.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC SENSORY NERVE CONDUCTION STUDY
|
Facility
|
IP
|
$223.00
|
|
| Hospital Charge Code |
900600258
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.52
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
|
|
HC SENSORY NERVE CONDUCTION STUDY
|
Facility
|
OP
|
$223.00
|
|
| Hospital Charge Code |
900600258
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.94
|
| Rate for Payer: Blue Shield of California Commercial |
$136.48
|
| Rate for Payer: Blue Shield of California EPN |
$90.09
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cigna of CA HMO |
$142.72
|
| Rate for Payer: Cigna of CA PPO |
$165.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.55
|
| Rate for Payer: Vantage Medical Group Senior |
$189.55
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$58.56 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$100.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Cigna of CA HMO |
$156.16
|
| Rate for Payer: Cigna of CA PPO |
$180.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$198.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC SENSURA MIO OSTOMY KIT RED
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.11
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC SENSURA MIO OSTOMY KIT RED
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC SENSURA MIO OSTOMY KIT YELLOW
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.11
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC SENSURA MIO OSTOMY KIT YELLOW
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
IP
|
$3,087.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$617.40 |
| Max. Negotiated Rate |
$2,623.95 |
| Rate for Payer: Adventist Health Commercial |
$617.40
|
| Rate for Payer: Cash Price |
$1,697.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,234.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,234.80
|
| Rate for Payer: Galaxy Health WC |
$2,623.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,852.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,059.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,176.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,910.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.88
|
| Rate for Payer: Multiplan Commercial |
$2,469.60
|
| Rate for Payer: Networks By Design Commercial |
$2,006.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,623.95
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
OP
|
$3,087.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$449.67 |
| Max. Negotiated Rate |
$2,623.95 |
| Rate for Payer: Adventist Health Commercial |
$617.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,024.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,895.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,889.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,247.15
|
| Rate for Payer: Cash Price |
$1,697.85
|
| Rate for Payer: Cash Price |
$1,697.85
|
| Rate for Payer: Cash Price |
$1,697.85
|
| Rate for Payer: Cigna of CA HMO |
$1,975.68
|
| Rate for Payer: Cigna of CA PPO |
$2,284.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$2,623.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,852.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$449.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,059.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$2,469.60
|
| Rate for Payer: Networks By Design Commercial |
$2,006.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,623.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,852.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,852.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC SERVO CONTROL STEEPER OR EQUAL
|
Facility
|
IP
|
$1,457.00
|
|
|
Service Code
|
CPT L7266
|
| Hospital Charge Code |
905357266
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$291.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$801.35
|
| Rate for Payer: Cash Price |
$801.35
|
| Rate for Payer: Cigna of CA HMO |
$1,019.90
|
| Rate for Payer: Cigna of CA PPO |
$1,019.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.80
|
| Rate for Payer: EPIC Health Plan Senior |
$582.80
|
| Rate for Payer: Galaxy Health WC |
$1,238.45
|
| Rate for Payer: Global Benefits Group Commercial |
$874.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$971.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$901.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.68
|
| Rate for Payer: Multiplan Commercial |
$1,165.60
|
| Rate for Payer: Networks By Design Commercial |
$728.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,238.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.81
|
| Rate for Payer: United Healthcare All Other HMO |
$532.24
|
| Rate for Payer: United Healthcare HMO Rider |
$520.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$477.17
|
|
|
HC SERVO CONTROL STEEPER OR EQUAL
|
Facility
|
OP
|
$1,457.00
|
|
|
Service Code
|
CPT L7266
|
| Hospital Charge Code |
905357266
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.68 |
| Max. Negotiated Rate |
$1,238.45 |
| Rate for Payer: Adventist Health Commercial |
$597.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,238.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$801.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,092.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$843.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,075.27
|
| Rate for Payer: Blue Shield of California EPN |
$708.10
|
| Rate for Payer: Cash Price |
$801.35
|
| Rate for Payer: Cigna of CA HMO |
$1,019.90
|
| Rate for Payer: Cigna of CA PPO |
$1,019.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,238.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,238.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,238.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.80
|
| Rate for Payer: EPIC Health Plan Senior |
$582.80
|
| Rate for Payer: Galaxy Health WC |
$1,238.45
|
| Rate for Payer: Global Benefits Group Commercial |
$874.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$971.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$901.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,019.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,019.90
|
| Rate for Payer: Multiplan Commercial |
$1,165.60
|
| Rate for Payer: Networks By Design Commercial |
$728.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,238.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$874.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$874.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.81
|
| Rate for Payer: United Healthcare All Other HMO |
$532.24
|
| Rate for Payer: United Healthcare HMO Rider |
$520.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$477.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,238.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,238.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,238.45
|
|
|
HC SET CATH ARTERIAL 22GA X 5CM
|
Facility
|
OP
|
$853.67
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$725.62 |
| Rate for Payer: Adventist Health Commercial |
$170.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$725.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$469.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$640.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.24
|
| Rate for Payer: Cash Price |
$469.52
|
| Rate for Payer: Cigna of CA HMO |
$546.35
|
| Rate for Payer: Cigna of CA PPO |
$631.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$725.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$725.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$725.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.47
|
| Rate for Payer: EPIC Health Plan Senior |
$341.47
|
| Rate for Payer: Galaxy Health WC |
$725.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$597.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$597.57
|
| Rate for Payer: Multiplan Commercial |
$682.94
|
| Rate for Payer: Networks By Design Commercial |
$554.89
|
| Rate for Payer: Prime Health Services Commercial |
$725.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.83
|
| Rate for Payer: United Healthcare All Other HMO |
$426.83
|
| Rate for Payer: United Healthcare HMO Rider |
$426.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$426.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$725.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$725.62
|
| Rate for Payer: Vantage Medical Group Senior |
$725.62
|
|
|
HC SET CATH ARTERIAL 22GA X 5CM
|
Facility
|
IP
|
$853.67
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$725.62 |
| Rate for Payer: Adventist Health Commercial |
$170.73
|
| Rate for Payer: Cash Price |
$469.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.47
|
| Rate for Payer: EPIC Health Plan Senior |
$341.47
|
| Rate for Payer: Galaxy Health WC |
$725.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.88
|
| Rate for Payer: Multiplan Commercial |
$682.94
|
| Rate for Payer: Networks By Design Commercial |
$554.89
|
| Rate for Payer: Prime Health Services Commercial |
$725.62
|
|
|
HC SET CATH ARTERIAL 24GA X 2.5CM
|
Facility
|
OP
|
$853.67
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$725.62 |
| Rate for Payer: Adventist Health Commercial |
$170.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$725.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$469.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$640.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.24
|
| Rate for Payer: Cash Price |
$469.52
|
| Rate for Payer: Cigna of CA HMO |
$546.35
|
| Rate for Payer: Cigna of CA PPO |
$631.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$725.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$725.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$725.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.47
|
| Rate for Payer: EPIC Health Plan Senior |
$341.47
|
| Rate for Payer: Galaxy Health WC |
$725.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$597.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$597.57
|
| Rate for Payer: Multiplan Commercial |
$682.94
|
| Rate for Payer: Networks By Design Commercial |
$554.89
|
| Rate for Payer: Prime Health Services Commercial |
$725.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.83
|
| Rate for Payer: United Healthcare All Other HMO |
$426.83
|
| Rate for Payer: United Healthcare HMO Rider |
$426.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$426.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$725.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$725.62
|
| Rate for Payer: Vantage Medical Group Senior |
$725.62
|
|
|
HC SET CATH ARTERIAL 24GA X 2.5CM
|
Facility
|
IP
|
$853.67
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$725.62 |
| Rate for Payer: Adventist Health Commercial |
$170.73
|
| Rate for Payer: Cash Price |
$469.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.47
|
| Rate for Payer: EPIC Health Plan Senior |
$341.47
|
| Rate for Payer: Galaxy Health WC |
$725.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.88
|
| Rate for Payer: Multiplan Commercial |
$682.94
|
| Rate for Payer: Networks By Design Commercial |
$554.89
|
| Rate for Payer: Prime Health Services Commercial |
$725.62
|
|
|
HC SET CATH ARTERIAL 24GA X 5CM
|
Facility
|
OP
|
$136.65
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$116.15 |
| Rate for Payer: Adventist Health Commercial |
$27.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.92
|
| Rate for Payer: Cash Price |
$75.16
|
| Rate for Payer: Cigna of CA HMO |
$87.46
|
| Rate for Payer: Cigna of CA PPO |
$101.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.66
|
| Rate for Payer: EPIC Health Plan Senior |
$54.66
|
| Rate for Payer: Galaxy Health WC |
$116.15
|
| Rate for Payer: Global Benefits Group Commercial |
$81.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.66
|
| Rate for Payer: Multiplan Commercial |
$109.32
|
| Rate for Payer: Networks By Design Commercial |
$88.82
|
| Rate for Payer: Prime Health Services Commercial |
$116.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.33
|
| Rate for Payer: United Healthcare All Other HMO |
$68.33
|
| Rate for Payer: United Healthcare HMO Rider |
$68.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.15
|
| Rate for Payer: Vantage Medical Group Senior |
$116.15
|
|
|
HC SET CATH ARTERIAL 24GA X 5CM
|
Facility
|
IP
|
$136.65
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$116.15 |
| Rate for Payer: Adventist Health Commercial |
$27.33
|
| Rate for Payer: Cash Price |
$75.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.66
|
| Rate for Payer: EPIC Health Plan Senior |
$54.66
|
| Rate for Payer: Galaxy Health WC |
$116.15
|
| Rate for Payer: Global Benefits Group Commercial |
$81.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Multiplan Commercial |
$109.32
|
| Rate for Payer: Networks By Design Commercial |
$88.82
|
| Rate for Payer: Prime Health Services Commercial |
$116.15
|
|
|
HC SET CATH RADIAL ARTRY 22GA
|
Facility
|
IP
|
$79.79
|
|
| Hospital Charge Code |
901602677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$67.82 |
| Rate for Payer: Adventist Health Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$43.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.92
|
| Rate for Payer: EPIC Health Plan Senior |
$31.92
|
| Rate for Payer: Galaxy Health WC |
$67.82
|
| Rate for Payer: Global Benefits Group Commercial |
$47.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.15
|
| Rate for Payer: Multiplan Commercial |
$63.83
|
| Rate for Payer: Networks By Design Commercial |
$51.86
|
| Rate for Payer: Prime Health Services Commercial |
$67.82
|
|
|
HC SET CATH RADIAL ARTRY 22GA
|
Facility
|
OP
|
$79.79
|
|
| Hospital Charge Code |
901602677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$67.82 |
| Rate for Payer: Adventist Health Commercial |
$15.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.00
|
| Rate for Payer: Cash Price |
$43.88
|
| Rate for Payer: Cigna of CA HMO |
$51.07
|
| Rate for Payer: Cigna of CA PPO |
$59.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.92
|
| Rate for Payer: EPIC Health Plan Senior |
$31.92
|
| Rate for Payer: Galaxy Health WC |
$67.82
|
| Rate for Payer: Global Benefits Group Commercial |
$47.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.85
|
| Rate for Payer: Multiplan Commercial |
$63.83
|
| Rate for Payer: Networks By Design Commercial |
$51.86
|
| Rate for Payer: Prime Health Services Commercial |
$67.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.90
|
| Rate for Payer: United Healthcare All Other HMO |
$39.90
|
| Rate for Payer: United Healthcare HMO Rider |
$39.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.82
|
| Rate for Payer: Vantage Medical Group Senior |
$67.82
|
|
|
HC SET DIALYNATE PERITONEAL
|
Facility
|
IP
|
$573.62
|
|
| Hospital Charge Code |
901605981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$487.58 |
| Rate for Payer: Adventist Health Commercial |
$114.72
|
| Rate for Payer: Cash Price |
$315.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.45
|
| Rate for Payer: EPIC Health Plan Senior |
$229.45
|
| Rate for Payer: Galaxy Health WC |
$487.58
|
| Rate for Payer: Global Benefits Group Commercial |
$344.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.67
|
| Rate for Payer: Multiplan Commercial |
$458.90
|
| Rate for Payer: Networks By Design Commercial |
$372.85
|
| Rate for Payer: Prime Health Services Commercial |
$487.58
|
|
|
HC SET DIALYNATE PERITONEAL
|
Facility
|
OP
|
$573.62
|
|
| Hospital Charge Code |
901605981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$487.58 |
| Rate for Payer: Adventist Health Commercial |
$114.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$487.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.26
|
| Rate for Payer: Cash Price |
$315.49
|
| Rate for Payer: Cigna of CA HMO |
$367.12
|
| Rate for Payer: Cigna of CA PPO |
$424.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$487.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.45
|
| Rate for Payer: EPIC Health Plan Senior |
$229.45
|
| Rate for Payer: Galaxy Health WC |
$487.58
|
| Rate for Payer: Global Benefits Group Commercial |
$344.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.53
|
| Rate for Payer: Multiplan Commercial |
$458.90
|
| Rate for Payer: Networks By Design Commercial |
$372.85
|
| Rate for Payer: Prime Health Services Commercial |
$487.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.81
|
| Rate for Payer: United Healthcare All Other HMO |
$286.81
|
| Rate for Payer: United Healthcare HMO Rider |
$286.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.58
|
| Rate for Payer: Vantage Medical Group Senior |
$487.58
|
|
|
HC SET FUHRMAN DRAIN CATH 8.5FR
|
Facility
|
IP
|
$594.32
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.86 |
| Max. Negotiated Rate |
$505.17 |
| Rate for Payer: Adventist Health Commercial |
$118.86
|
| Rate for Payer: Cash Price |
$326.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.73
|
| Rate for Payer: EPIC Health Plan Senior |
$237.73
|
| Rate for Payer: Galaxy Health WC |
$505.17
|
| Rate for Payer: Global Benefits Group Commercial |
$356.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$367.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.64
|
| Rate for Payer: Multiplan Commercial |
$475.46
|
| Rate for Payer: Networks By Design Commercial |
$386.31
|
| Rate for Payer: Prime Health Services Commercial |
$505.17
|
|
