|
HC SEWHO ERBS PALSY DESIGN
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
905353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.68 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Adventist Health Commercial |
$669.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,224.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,204.42
|
| Rate for Payer: Blue Shield of California EPN |
$793.15
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,387.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,387.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.80
|
| Rate for Payer: EPIC Health Plan Senior |
$652.80
|
| Rate for Payer: Galaxy Health WC |
$1,387.20
|
| Rate for Payer: Global Benefits Group Commercial |
$979.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$666.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,010.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,142.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,142.40
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.49
|
| Rate for Payer: United Healthcare All Other HMO |
$596.17
|
| Rate for Payer: United Healthcare HMO Rider |
$583.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,387.20
|
|
|
HC SEWHO ERBS PALSY DESIGN
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
915353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.80
|
| Rate for Payer: EPIC Health Plan Senior |
$652.80
|
| Rate for Payer: Galaxy Health WC |
$1,387.20
|
| Rate for Payer: Global Benefits Group Commercial |
$979.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,010.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.68
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.49
|
| Rate for Payer: United Healthcare All Other HMO |
$596.17
|
| Rate for Payer: United Healthcare HMO Rider |
$583.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.48
|
|
|
HC SEWHO ERBS PALSY DESIGN
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
905353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.80
|
| Rate for Payer: EPIC Health Plan Senior |
$652.80
|
| Rate for Payer: Galaxy Health WC |
$1,387.20
|
| Rate for Payer: Global Benefits Group Commercial |
$979.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,010.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.68
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.49
|
| Rate for Payer: United Healthcare All Other HMO |
$596.17
|
| Rate for Payer: United Healthcare HMO Rider |
$583.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.48
|
|
|
HC SEWHO ERBS PALSY DESIGN
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
915353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.68 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Adventist Health Commercial |
$669.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,224.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,204.42
|
| Rate for Payer: Blue Shield of California EPN |
$793.15
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,387.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,387.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.80
|
| Rate for Payer: EPIC Health Plan Senior |
$652.80
|
| Rate for Payer: Galaxy Health WC |
$1,387.20
|
| Rate for Payer: Global Benefits Group Commercial |
$979.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$666.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,010.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,142.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,142.40
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.49
|
| Rate for Payer: United Healthcare All Other HMO |
$596.17
|
| Rate for Payer: United Healthcare HMO Rider |
$583.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,387.20
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna of CA HMO |
$354.56
|
| Rate for Payer: Cigna of CA PPO |
$409.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$443.20
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$332.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$277.00
|
| Rate for Payer: United Healthcare All Other HMO |
$277.00
|
| Rate for Payer: United Healthcare HMO Rider |
$277.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.60
|
| Rate for Payer: EPIC Health Plan Senior |
$221.60
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.96
|
| Rate for Payer: Multiplan Commercial |
$443.20
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
|
|
HC SHEATH GLIDETHRU 4.5FR 7CM
|
Facility
|
IP
|
$114.76
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$97.55 |
| Rate for Payer: Adventist Health Commercial |
$22.95
|
| Rate for Payer: Cash Price |
$51.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.90
|
| Rate for Payer: EPIC Health Plan Senior |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$97.55
|
| Rate for Payer: Global Benefits Group Commercial |
$68.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.54
|
| Rate for Payer: Multiplan Commercial |
$91.81
|
| Rate for Payer: Networks By Design Commercial |
$74.59
|
| Rate for Payer: Prime Health Services Commercial |
$97.55
|
|
|
HC SHEATH GLIDETHRU 4.5FR 7CM
|
Facility
|
OP
|
$114.76
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$97.55 |
| Rate for Payer: Adventist Health Commercial |
$22.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.47
|
| Rate for Payer: Cash Price |
$51.64
|
| Rate for Payer: Cigna of CA HMO |
$73.45
|
| Rate for Payer: Cigna of CA PPO |
$84.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.90
|
| Rate for Payer: EPIC Health Plan Senior |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$97.55
|
| Rate for Payer: Global Benefits Group Commercial |
$68.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.33
|
| Rate for Payer: Multiplan Commercial |
$91.81
|
| Rate for Payer: Networks By Design Commercial |
$74.59
|
| Rate for Payer: Prime Health Services Commercial |
$97.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.38
|
| Rate for Payer: United Healthcare All Other HMO |
$57.38
|
| Rate for Payer: United Healthcare HMO Rider |
$57.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.55
|
| Rate for Payer: Vantage Medical Group Senior |
$97.55
|
|
|
HC SHEATH GLIDETHRU 4FR 7CM
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.96
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
|
|
HC SHEATH GLIDETHRU 4FR 7CM
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.57
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.80
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.00
|
| Rate for Payer: United Healthcare All Other HMO |
$77.00
|
| Rate for Payer: United Healthcare HMO Rider |
$77.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Vantage Medical Group Senior |
$130.90
|
|
|
HC SHEATH GLIDETHRU 5.5FR 7CM
|
Facility
|
OP
|
$111.72
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$94.96 |
| Rate for Payer: Adventist Health Commercial |
$22.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.61
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO |
$71.50
|
| Rate for Payer: Cigna of CA PPO |
$82.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.69
|
| Rate for Payer: EPIC Health Plan Senior |
$44.69
|
| Rate for Payer: Galaxy Health WC |
$94.96
|
| Rate for Payer: Global Benefits Group Commercial |
$67.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$89.38
|
| Rate for Payer: Networks By Design Commercial |
$72.62
|
| Rate for Payer: Prime Health Services Commercial |
$94.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.86
|
| Rate for Payer: United Healthcare All Other HMO |
$55.86
|
| Rate for Payer: United Healthcare HMO Rider |
$55.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.96
|
| Rate for Payer: Vantage Medical Group Senior |
$94.96
|
|
|
HC SHEATH GLIDETHRU 5.5FR 7CM
|
Facility
|
IP
|
$111.72
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$94.96 |
| Rate for Payer: Adventist Health Commercial |
$22.34
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.69
|
| Rate for Payer: EPIC Health Plan Senior |
$44.69
|
| Rate for Payer: Galaxy Health WC |
$94.96
|
| Rate for Payer: Global Benefits Group Commercial |
$67.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.81
|
| Rate for Payer: Multiplan Commercial |
$89.38
|
| Rate for Payer: Networks By Design Commercial |
$72.62
|
| Rate for Payer: Prime Health Services Commercial |
$94.96
|
|
|
HC SHEATH GLIDETHRU 5FR 7CM
|
Facility
|
OP
|
$114.76
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$97.55 |
| Rate for Payer: Adventist Health Commercial |
$22.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.47
|
| Rate for Payer: Cash Price |
$51.64
|
| Rate for Payer: Cigna of CA HMO |
$73.45
|
| Rate for Payer: Cigna of CA PPO |
$84.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.90
|
| Rate for Payer: EPIC Health Plan Senior |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$97.55
|
| Rate for Payer: Global Benefits Group Commercial |
$68.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.33
|
| Rate for Payer: Multiplan Commercial |
$91.81
|
| Rate for Payer: Networks By Design Commercial |
$74.59
|
| Rate for Payer: Prime Health Services Commercial |
$97.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.38
|
| Rate for Payer: United Healthcare All Other HMO |
$57.38
|
| Rate for Payer: United Healthcare HMO Rider |
$57.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.55
|
| Rate for Payer: Vantage Medical Group Senior |
$97.55
|
|
|
HC SHEATH GLIDETHRU 5FR 7CM
|
Facility
|
IP
|
$114.76
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$97.55 |
| Rate for Payer: Adventist Health Commercial |
$22.95
|
| Rate for Payer: Cash Price |
$51.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.90
|
| Rate for Payer: EPIC Health Plan Senior |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$97.55
|
| Rate for Payer: Global Benefits Group Commercial |
$68.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.54
|
| Rate for Payer: Multiplan Commercial |
$91.81
|
| Rate for Payer: Networks By Design Commercial |
$74.59
|
| Rate for Payer: Prime Health Services Commercial |
$97.55
|
|
|
HC SHEATH GLIDETHRU 6FR 7CM
|
Facility
|
IP
|
$111.72
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$94.96 |
| Rate for Payer: Adventist Health Commercial |
$22.34
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.69
|
| Rate for Payer: EPIC Health Plan Senior |
$44.69
|
| Rate for Payer: Galaxy Health WC |
$94.96
|
| Rate for Payer: Global Benefits Group Commercial |
$67.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.81
|
| Rate for Payer: Multiplan Commercial |
$89.38
|
| Rate for Payer: Networks By Design Commercial |
$72.62
|
| Rate for Payer: Prime Health Services Commercial |
$94.96
|
|
|
HC SHEATH GLIDETHRU 6FR 7CM
|
Facility
|
OP
|
$111.72
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$94.96 |
| Rate for Payer: Adventist Health Commercial |
$22.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.61
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO |
$71.50
|
| Rate for Payer: Cigna of CA PPO |
$82.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.69
|
| Rate for Payer: EPIC Health Plan Senior |
$44.69
|
| Rate for Payer: Galaxy Health WC |
$94.96
|
| Rate for Payer: Global Benefits Group Commercial |
$67.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$89.38
|
| Rate for Payer: Networks By Design Commercial |
$72.62
|
| Rate for Payer: Prime Health Services Commercial |
$94.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.86
|
| Rate for Payer: United Healthcare All Other HMO |
$55.86
|
| Rate for Payer: United Healthcare HMO Rider |
$55.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.96
|
| Rate for Payer: Vantage Medical Group Senior |
$94.96
|
|
|
HC SHEATH INTRODUCER KIT 8.5FR
|
Facility
|
IP
|
$641.15
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$544.98 |
| Rate for Payer: Adventist Health Commercial |
$128.23
|
| Rate for Payer: Cash Price |
$288.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.46
|
| Rate for Payer: EPIC Health Plan Senior |
$256.46
|
| Rate for Payer: Galaxy Health WC |
$544.98
|
| Rate for Payer: Global Benefits Group Commercial |
$384.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$396.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.88
|
| Rate for Payer: Multiplan Commercial |
$512.92
|
| Rate for Payer: Networks By Design Commercial |
$416.75
|
| Rate for Payer: Prime Health Services Commercial |
$544.98
|
|
|
HC SHEATH INTRODUCER KIT 8.5FR
|
Facility
|
OP
|
$641.15
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$544.98 |
| Rate for Payer: Adventist Health Commercial |
$128.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$544.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$352.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$393.73
|
| Rate for Payer: Cash Price |
$288.52
|
| Rate for Payer: Cigna of CA HMO |
$410.34
|
| Rate for Payer: Cigna of CA PPO |
$474.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$544.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$544.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$544.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.46
|
| Rate for Payer: EPIC Health Plan Senior |
$256.46
|
| Rate for Payer: Galaxy Health WC |
$544.98
|
| Rate for Payer: Global Benefits Group Commercial |
$384.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$396.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$448.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$448.81
|
| Rate for Payer: Multiplan Commercial |
$512.92
|
| Rate for Payer: Networks By Design Commercial |
$416.75
|
| Rate for Payer: Prime Health Services Commercial |
$544.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$320.57
|
| Rate for Payer: United Healthcare All Other HMO |
$320.57
|
| Rate for Payer: United Healthcare HMO Rider |
$320.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$544.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$544.98
|
| Rate for Payer: Vantage Medical Group Senior |
$544.98
|
|
|
HC SHEATH INTRODUCER KIT 9FR
|
Facility
|
IP
|
$691.33
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.27 |
| Max. Negotiated Rate |
$587.63 |
| Rate for Payer: Adventist Health Commercial |
$138.27
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.53
|
| Rate for Payer: EPIC Health Plan Senior |
$276.53
|
| Rate for Payer: Galaxy Health WC |
$587.63
|
| Rate for Payer: Global Benefits Group Commercial |
$414.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$461.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$427.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.92
|
| Rate for Payer: Multiplan Commercial |
$553.06
|
| Rate for Payer: Networks By Design Commercial |
$449.36
|
| Rate for Payer: Prime Health Services Commercial |
$587.63
|
|
|
HC SHEATH INTRODUCER KIT 9FR
|
Facility
|
OP
|
$691.33
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.27 |
| Max. Negotiated Rate |
$587.63 |
| Rate for Payer: Adventist Health Commercial |
$138.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$453.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$380.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$518.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.55
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cigna of CA HMO |
$442.45
|
| Rate for Payer: Cigna of CA PPO |
$511.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$587.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$587.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.53
|
| Rate for Payer: EPIC Health Plan Senior |
$276.53
|
| Rate for Payer: Galaxy Health WC |
$587.63
|
| Rate for Payer: Global Benefits Group Commercial |
$414.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$461.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$427.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$483.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$483.93
|
| Rate for Payer: Multiplan Commercial |
$553.06
|
| Rate for Payer: Networks By Design Commercial |
$449.36
|
| Rate for Payer: Prime Health Services Commercial |
$587.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$345.67
|
| Rate for Payer: United Healthcare All Other HMO |
$345.67
|
| Rate for Payer: United Healthcare HMO Rider |
$345.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$345.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$587.63
|
| Rate for Payer: Vantage Medical Group Senior |
$587.63
|
|
|
HC SHEATH NEEDLE (COOK)
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Senior |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC SHEATH NEEDLE (COOK)
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.24
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Senior |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.10
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.50
|
| Rate for Payer: United Healthcare All Other HMO |
$86.50
|
| Rate for Payer: United Healthcare HMO Rider |
$86.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.05
|
| Rate for Payer: Vantage Medical Group Senior |
$147.05
|
|
|
HC SHEATH SET/11CM (COOK)
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.69
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SHEATH SET/11CM (COOK)
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SHEATH SET/30-80CM
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
