|
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 |
$84.70
|
| 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 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 |
$61.45
|
| 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 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 |
$61.45
|
| 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 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 |
$63.12
|
| 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 |
$63.12
|
| 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
|
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 |
$61.45
|
| 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 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 |
$61.45
|
| 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 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 |
$352.63
|
| 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 |
$352.63
|
| 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 |
$380.23
|
| 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 |
$380.23
|
| 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 |
$95.15
|
| 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 |
$95.15
|
| 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 |
$66.00
|
| 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 |
$66.00
|
| 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
|
OP
|
$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: Aetna of CA HMO/PPO |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$190.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.98
|
| Rate for Payer: Cash Price |
$139.70
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.90
|
| 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: Molina Healthcare of CA Medi-Cal |
$177.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.80
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.00
|
| Rate for Payer: United Healthcare All Other HMO |
$127.00
|
| Rate for Payer: United Healthcare HMO Rider |
$127.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
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 |
$139.70
|
| 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
|
|
|
HC SHIGATOXIN
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.70
|
| Rate for Payer: Blue Shield of California Commercial |
$124.43
|
| Rate for Payer: Blue Shield of California EPN |
$82.21
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SHIGATOXIN
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.60
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna of CA HMO |
$390.40
|
| Rate for Payer: Cigna of CA PPO |
$451.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$427.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$427.00
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.00
|
| Rate for Payer: United Healthcare All Other HMO |
$305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$305.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$305.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
|
IP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC SHILEY PDL 5.0
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PDL 5.0
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.63
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 5.5
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
|
|
HC SHILEY PDL 5.5
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.63
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Cigna of CA HMO |
$148.65
|
| Rate for Payer: Cigna of CA PPO |
$171.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.90
|
| Rate for Payer: EPIC Health Plan Senior |
$92.90
|
| Rate for Payer: Galaxy Health WC |
$197.42
|
| Rate for Payer: Global Benefits Group Commercial |
$139.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$185.81
|
| Rate for Payer: Networks By Design Commercial |
$150.97
|
| Rate for Payer: Prime Health Services Commercial |
$197.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Other HMO |
$116.13
|
| Rate for Payer: United Healthcare HMO Rider |
$116.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
