|
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 |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$120.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.77
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| 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 |
901300064
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.61 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$120.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.77
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| 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
|
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 |
$143.10
|
| Rate for Payer: Blue Shield of California Commercial |
$93.88
|
| Rate for Payer: Blue Shield of California Commercial |
$142.27
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| 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 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 |
$100.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| 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 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 |
$659.42 |
| Rate for Payer: Adventist Health Commercial |
$100.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$659.42
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.96
|
| 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 |
$109.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.96
|
| 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 |
$14.04 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.04
|
| 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 |
$8.47
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| 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 |
$5.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| 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
|
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 |
$5.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| 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 |
$17.10 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.10
|
| 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 |
$8.47
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| 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 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 |
$1,389.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,160.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,960.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,821.33
|
| 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 |
$1,757.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,980.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,299.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,969.51
|
| Rate for Payer: Cash Price |
$1,389.15
|
| Rate for Payer: Cash Price |
$1,389.15
|
| Rate for Payer: Cash Price |
$1,389.15
|
| 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 |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,160.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.93
|
| 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/Senior |
$1,811.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$449.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,960.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$508.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,546.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,391.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,480.00
|
| 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 |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC SES I 1 (SESAME), IGE
|
Facility
|
OP
|
$13.72
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913730
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$170.73 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.73
|
| Rate for Payer: Blue Shield of California Commercial |
$11.47
|
| Rate for Payer: Blue Shield of California Commercial |
$6.32
|
| Rate for Payer: Blue Shield of California Commercial |
$7.59
|
| Rate for Payer: Blue Shield of California Commercial |
$9.56
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cigna of CA HMO |
$10.53
|
| Rate for Payer: Cigna of CA HMO |
$8.78
|
| Rate for Payer: Cigna of CA PPO |
$10.15
|
| Rate for Payer: Cigna of CA PPO |
$12.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$11.66
|
| Rate for Payer: Galaxy Health WC |
$13.99
|
| Rate for Payer: Global Benefits Group Commercial |
$8.23
|
| Rate for Payer: Global Benefits Group Commercial |
$9.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.17
|
| Rate for Payer: Multiplan Commercial |
$10.98
|
| Rate for Payer: Networks By Design Commercial |
$10.70
|
| Rate for Payer: Networks By Design Commercial |
$8.92
|
| Rate for Payer: Prime Health Services Commercial |
$11.66
|
| Rate for Payer: Prime Health Services Commercial |
$13.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
|
|
HC SES I 1 (SESAME), IGE
|
Facility
|
IP
|
$16.46
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913730
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: EPIC Health Plan Senior |
$6.58
|
| Rate for Payer: Galaxy Health WC |
$13.99
|
| Rate for Payer: Global Benefits Group Commercial |
$9.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$13.17
|
| Rate for Payer: Networks By Design Commercial |
$10.70
|
| Rate for Payer: Prime Health Services Commercial |
$13.99
|
|
|
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 |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$170.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.59
|
| 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 |
$547.80
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Cash Price |
$384.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$597.57
|
| 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 Foundation Hospitals Commercial/Self Funded |
$542.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$503.67
|
| 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 |
$384.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$597.57
|
| 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 Foundation Hospitals Commercial/Self Funded |
$542.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$503.67
|
| 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 |
$1,155.59 |
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Cigna of CA HMO |
$546.35
|
| Rate for Payer: Cigna of CA PPO |
$631.72
|
| Rate for Payer: Adventist Health Commercial |
$170.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.59
|
| 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 |
$547.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$597.57
|
| 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 Foundation Hospitals Commercial/Self Funded |
$542.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$503.67
|
| 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 |
$384.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$597.57
|
| 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 Foundation Hospitals Commercial/Self Funded |
$542.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$503.67
|
| 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
|
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 |
$61.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.66
|
| 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 Foundation Hospitals Commercial/Self Funded |
$86.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.62
|
| 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 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 |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$27.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.59
|
| 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 |
$87.69
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cash Price |
$61.49
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.66
|
| 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 Foundation Hospitals Commercial/Self Funded |
$86.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.62
|
| 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 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 |
$35.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.85
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.08
|
| 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 |
$51.20
|
| Rate for Payer: Cash Price |
$35.91
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.85
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.08
|
| 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 |
$258.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$401.53
|
| 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 Foundation Hospitals Commercial/Self Funded |
$364.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$338.44
|
| 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 |
$368.09
|
| Rate for Payer: Cash Price |
$258.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$401.53
|
| 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 Foundation Hospitals Commercial/Self Funded |
$364.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$338.44
|
| 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 |
$267.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$377.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.65
|
| 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
|
|
