|
HC BAG VNTRL WALL DFCT SILO 7.5
|
Facility
|
IP
|
$2,194.20
|
|
| Hospital Charge Code |
901604782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.84 |
| Max. Negotiated Rate |
$1,974.78 |
| Rate for Payer: Adventist Health Commercial |
$438.84
|
| Rate for Payer: Cash Price |
$1,206.81
|
| Rate for Payer: Central Health Plan Commercial |
$1,755.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.68
|
| Rate for Payer: EPIC Health Plan Senior |
$877.68
|
| Rate for Payer: Galaxy Health WC |
$1,865.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,974.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.84
|
| Rate for Payer: Multiplan Commercial |
$1,645.65
|
| Rate for Payer: Networks By Design Commercial |
$1,426.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,865.07
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$40.06
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC BAL ANGSCR ANGIOSCULPT CUTTING
|
Facility
|
IP
|
$3,120.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
906812366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,808.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,931.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Networks By Design Commercial |
$2,028.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
|
|
HC BAL ANGSCR ANGIOSCULPT CUTTING
|
Facility
|
OP
|
$3,120.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
906812366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,894.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,716.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,340.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,510.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,832.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,906.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,244.88
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Cigna of CA HMO |
$1,996.80
|
| Rate for Payer: Cigna of CA PPO |
$2,308.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,652.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,808.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,931.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,184.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,184.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Networks By Design Commercial |
$2,028.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,248.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,872.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,872.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,652.00
|
|
|
HC BAL BARD ATLAS GOLD
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.80 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Central Health Plan Commercial |
$479.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: EPIC Health Plan Senior |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$539.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.80
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
|
|
HC BAL BARD ATLAS GOLD
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.80 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$363.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$329.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$290.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.79
|
| Rate for Payer: Blue Shield of California Commercial |
$365.99
|
| Rate for Payer: Blue Shield of California EPN |
$239.00
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Central Health Plan Commercial |
$479.20
|
| Rate for Payer: Cigna of CA HMO |
$383.36
|
| Rate for Payer: Cigna of CA PPO |
$443.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$509.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$509.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: EPIC Health Plan Senior |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$539.10
|
| Rate for Payer: InnovAge PACE Commercial |
$299.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$419.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$419.30
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
| Rate for Payer: Riverside University Health System MISP |
$239.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$359.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$359.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.50
|
| Rate for Payer: United Healthcare All Other HMO |
$299.50
|
| Rate for Payer: United Healthcare HMO Rider |
$299.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$509.15
|
| Rate for Payer: Vantage Medical Group Senior |
$509.15
|
|
|
HC BAL BARD ATLAS PTA
|
Facility
|
OP
|
$1,610.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Adventist Health Commercial |
$322.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$977.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$885.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,207.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$779.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.55
|
| Rate for Payer: Blue Shield of California Commercial |
$983.71
|
| Rate for Payer: Blue Shield of California EPN |
$642.39
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,288.00
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,191.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,368.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,368.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$644.00
|
| Rate for Payer: Galaxy Health WC |
$1,368.50
|
| Rate for Payer: Global Benefits Group Commercial |
$966.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,449.00
|
| Rate for Payer: InnovAge PACE Commercial |
$805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,127.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,127.00
|
| Rate for Payer: Multiplan Commercial |
$1,207.50
|
| Rate for Payer: Networks By Design Commercial |
$1,046.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,368.50
|
| Rate for Payer: Riverside University Health System MISP |
$644.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$966.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$966.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$805.00
|
| Rate for Payer: United Healthcare All Other HMO |
$805.00
|
| Rate for Payer: United Healthcare HMO Rider |
$805.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$805.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,368.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,368.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,368.50
|
|
|
HC BAL BARD ATLAS PTA
|
Facility
|
IP
|
$1,610.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Adventist Health Commercial |
$322.00
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,288.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$644.00
|
| Rate for Payer: Galaxy Health WC |
$1,368.50
|
| Rate for Payer: Global Benefits Group Commercial |
$966.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,449.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$1,207.50
|
| Rate for Payer: Networks By Design Commercial |
$1,046.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,368.50
|
|
|
HC BAL BARD DORADO
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Blue Shield of California Commercial |
$657.82
|
| Rate for Payer: Blue Shield of California EPN |
$428.90
|
| Rate for Payer: Cash Price |
$468.05
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: Cigna of CA HMO |
$595.70
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$425.50
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.38
|
| Rate for Payer: United Healthcare All Other HMO |
$310.87
|
| Rate for Payer: United Healthcare HMO Rider |
$304.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.70
|
|
|
HC BAL BARD DORADO
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$468.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$638.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$388.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$471.20
|
| Rate for Payer: Blue Shield of California Commercial |
$657.82
|
| Rate for Payer: Blue Shield of California EPN |
$428.90
|
| Rate for Payer: Cash Price |
$468.05
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: Cigna of CA HMO |
$595.70
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$723.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$723.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$723.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: InnovAge PACE Commercial |
$425.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.70
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$425.50
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: Riverside University Health System MISP |
$340.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.38
|
| Rate for Payer: United Healthcare All Other HMO |
$310.87
|
| Rate for Payer: United Healthcare HMO Rider |
$304.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$723.35
|
| Rate for Payer: Vantage Medical Group Senior |
$723.35
|
|
|
HC BAL BARD TRUE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BAL BARD TRUE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC BAL BP STINGRAY
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BAL BP STINGRAY
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC BAL BRAUN COEFFICIENT
|
Facility
|
IP
|
$1,863.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,676.70 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,440.10
|
| Rate for Payer: Blue Shield of California EPN |
$938.95
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,490.40
|
| Rate for Payer: Cigna of CA HMO |
$1,304.10
|
| Rate for Payer: Cigna of CA PPO |
$1,304.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,676.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.60
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Networks By Design Commercial |
$931.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.18
|
| Rate for Payer: United Healthcare All Other HMO |
$680.55
|
| Rate for Payer: United Healthcare HMO Rider |
$665.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.13
|
|
|
HC BAL BRAUN COEFFICIENT
|
Facility
|
OP
|
$1,863.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,676.70 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,024.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,397.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$850.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,031.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,440.10
|
| Rate for Payer: Blue Shield of California EPN |
$938.95
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,490.40
|
| Rate for Payer: Cigna of CA HMO |
$1,304.10
|
| Rate for Payer: Cigna of CA PPO |
$1,304.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,583.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,583.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,676.70
|
| Rate for Payer: InnovAge PACE Commercial |
$931.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,304.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,304.10
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Networks By Design Commercial |
$931.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$745.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,117.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$699.18
|
| Rate for Payer: United Healthcare All Other HMO |
$680.55
|
| Rate for Payer: United Healthcare HMO Rider |
$665.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,583.55
|
|
|
HC BAL BRAUN NUCLEUS
|
Facility
|
IP
|
$854.07
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$768.66 |
| Rate for Payer: Adventist Health Commercial |
$170.81
|
| Rate for Payer: Cash Price |
$469.74
|
| Rate for Payer: Central Health Plan Commercial |
$683.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.63
|
| Rate for Payer: EPIC Health Plan Senior |
$341.63
|
| Rate for Payer: Galaxy Health WC |
$725.96
|
| Rate for Payer: Global Benefits Group Commercial |
$512.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.81
|
| Rate for Payer: Multiplan Commercial |
$640.55
|
| Rate for Payer: Networks By Design Commercial |
$555.15
|
| Rate for Payer: Prime Health Services Commercial |
$725.96
|
|
|
HC BAL BRAUN NUCLEUS
|
Facility
|
OP
|
$854.07
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$768.66 |
| Rate for Payer: Adventist Health Commercial |
$170.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$518.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$725.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$469.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$640.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$413.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$501.60
|
| Rate for Payer: Blue Shield of California Commercial |
$521.84
|
| Rate for Payer: Blue Shield of California EPN |
$340.77
|
| Rate for Payer: Cash Price |
$469.74
|
| Rate for Payer: Central Health Plan Commercial |
$683.26
|
| Rate for Payer: Cigna of CA HMO |
$546.60
|
| Rate for Payer: Cigna of CA PPO |
$632.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$725.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$725.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$725.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.63
|
| Rate for Payer: EPIC Health Plan Senior |
$341.63
|
| Rate for Payer: Galaxy Health WC |
$725.96
|
| Rate for Payer: Global Benefits Group Commercial |
$512.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.66
|
| Rate for Payer: InnovAge PACE Commercial |
$427.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$597.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$597.85
|
| Rate for Payer: Multiplan Commercial |
$640.55
|
| Rate for Payer: Networks By Design Commercial |
$555.15
|
| Rate for Payer: Prime Health Services Commercial |
$725.96
|
| Rate for Payer: Riverside University Health System MISP |
$341.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.04
|
| Rate for Payer: United Healthcare All Other HMO |
$427.04
|
| Rate for Payer: United Healthcare HMO Rider |
$427.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$725.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$725.96
|
| Rate for Payer: Vantage Medical Group Senior |
$725.96
|
|
|
HC BAL BRAUN TYSHAK MINI
|
Facility
|
IP
|
$2,103.07
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.61 |
| Max. Negotiated Rate |
$1,892.76 |
| Rate for Payer: Adventist Health Commercial |
$420.61
|
| Rate for Payer: Cash Price |
$1,156.69
|
| Rate for Payer: Central Health Plan Commercial |
$1,682.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$841.23
|
| Rate for Payer: EPIC Health Plan Senior |
$841.23
|
| Rate for Payer: Galaxy Health WC |
$1,787.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,892.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,402.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,301.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.61
|
| Rate for Payer: Multiplan Commercial |
$1,577.30
|
| Rate for Payer: Networks By Design Commercial |
$1,367.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,787.61
|
|
|
HC BAL BRAUN TYSHAK MINI
|
Facility
|
OP
|
$2,103.07
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.61 |
| Max. Negotiated Rate |
$1,892.76 |
| Rate for Payer: Adventist Health Commercial |
$420.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,277.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,787.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,156.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,577.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,018.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,235.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,284.98
|
| Rate for Payer: Blue Shield of California EPN |
$839.12
|
| Rate for Payer: Cash Price |
$1,156.69
|
| Rate for Payer: Central Health Plan Commercial |
$1,682.46
|
| Rate for Payer: Cigna of CA HMO |
$1,345.96
|
| Rate for Payer: Cigna of CA PPO |
$1,556.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,787.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,787.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,787.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$841.23
|
| Rate for Payer: EPIC Health Plan Senior |
$841.23
|
| Rate for Payer: Galaxy Health WC |
$1,787.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,892.76
|
| Rate for Payer: InnovAge PACE Commercial |
$1,051.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,402.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,301.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,472.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,472.15
|
| Rate for Payer: Multiplan Commercial |
$1,577.30
|
| Rate for Payer: Networks By Design Commercial |
$1,367.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,787.61
|
| Rate for Payer: Riverside University Health System MISP |
$841.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,261.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,261.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,051.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,051.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,051.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,051.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,787.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,787.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,787.61
|
|
|
HC BAL BRAUN Z-MED II 10CM SMALL
|
Facility
|
OP
|
$1,507.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.40 |
| Max. Negotiated Rate |
$1,356.30 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$828.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,130.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$688.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,164.91
|
| Rate for Payer: Blue Shield of California EPN |
$759.53
|
| Rate for Payer: Cash Price |
$828.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,205.60
|
| Rate for Payer: Cigna of CA HMO |
$1,054.90
|
| Rate for Payer: Cigna of CA PPO |
$1,054.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,280.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,280.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$602.80
|
| Rate for Payer: Galaxy Health WC |
$1,280.95
|
| Rate for Payer: Global Benefits Group Commercial |
$904.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,356.30
|
| Rate for Payer: InnovAge PACE Commercial |
$753.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,005.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$574.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$932.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,054.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,054.90
|
| Rate for Payer: Multiplan Commercial |
$1,130.25
|
| Rate for Payer: Networks By Design Commercial |
$753.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,280.95
|
| Rate for Payer: Riverside University Health System MISP |
$602.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$904.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$904.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$565.58
|
| Rate for Payer: United Healthcare All Other HMO |
$550.51
|
| Rate for Payer: United Healthcare HMO Rider |
$538.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$493.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,280.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,280.95
|
|
|
HC BAL BRAUN Z-MED II 10CM SMALL
|
Facility
|
IP
|
$1,507.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.40 |
| Max. Negotiated Rate |
$1,356.30 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,164.91
|
| Rate for Payer: Blue Shield of California EPN |
$759.53
|
| Rate for Payer: Cash Price |
$828.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,205.60
|
| Rate for Payer: Cigna of CA HMO |
$1,054.90
|
| Rate for Payer: Cigna of CA PPO |
$1,054.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$602.80
|
| Rate for Payer: Galaxy Health WC |
$1,280.95
|
| Rate for Payer: Global Benefits Group Commercial |
$904.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,356.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,005.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$574.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$932.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.40
|
| Rate for Payer: Multiplan Commercial |
$1,130.25
|
| Rate for Payer: Networks By Design Commercial |
$753.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,280.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$565.58
|
| Rate for Payer: United Healthcare All Other HMO |
$550.51
|
| Rate for Payer: United Healthcare HMO Rider |
$538.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$493.54
|
|
|
HC BAL BRAUN Z-MED II 12CM LARGER
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,050.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,273.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,777.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC BAL BRAUN Z-MED II 12CM LARGER
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,777.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
