|
HC CASH ROBOTIC THERAPY SESSION
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 97799
|
| Hospital Charge Code |
915197799
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Central Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC CASTING 3" TCC-EZ SINGLE APP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
901698310
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CASTING 3" TCC-EZ SINGLE APP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
901698310
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC CASTING 4" TCC-EZ SINGLE APP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
901698311
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CASTING 4" TCC-EZ SINGLE APP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
901698311
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC CAST OFF LOADER KIT
|
Facility
|
OP
|
$556.57
|
|
|
Service Code
|
CPT A6452
|
| Hospital Charge Code |
901698871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$111.31 |
| Max. Negotiated Rate |
$500.91 |
| Rate for Payer: Adventist Health Commercial |
$111.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$338.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$473.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$417.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.87
|
| Rate for Payer: Blue Shield of California Commercial |
$340.06
|
| Rate for Payer: Blue Shield of California EPN |
$222.07
|
| Rate for Payer: Cash Price |
$306.11
|
| Rate for Payer: Central Health Plan Commercial |
$445.26
|
| Rate for Payer: Cigna of CA HMO |
$356.20
|
| Rate for Payer: Cigna of CA PPO |
$411.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$473.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$473.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$473.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.63
|
| Rate for Payer: EPIC Health Plan Senior |
$222.63
|
| Rate for Payer: Galaxy Health WC |
$473.08
|
| Rate for Payer: Global Benefits Group Commercial |
$333.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$500.91
|
| Rate for Payer: InnovAge PACE Commercial |
$278.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$371.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$344.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.60
|
| Rate for Payer: Multiplan Commercial |
$417.43
|
| Rate for Payer: Networks By Design Commercial |
$361.77
|
| Rate for Payer: Prime Health Services Commercial |
$473.08
|
| Rate for Payer: Riverside University Health System MISP |
$222.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$278.29
|
| Rate for Payer: United Healthcare All Other HMO |
$278.29
|
| Rate for Payer: United Healthcare HMO Rider |
$278.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$473.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$473.08
|
| Rate for Payer: Vantage Medical Group Senior |
$473.08
|
|
|
HC CAST OFF LOADER KIT
|
Facility
|
IP
|
$556.57
|
|
|
Service Code
|
CPT A6452
|
| Hospital Charge Code |
901698871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$111.31 |
| Max. Negotiated Rate |
$500.91 |
| Rate for Payer: Adventist Health Commercial |
$111.31
|
| Rate for Payer: Cash Price |
$306.11
|
| Rate for Payer: Central Health Plan Commercial |
$445.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.63
|
| Rate for Payer: EPIC Health Plan Senior |
$222.63
|
| Rate for Payer: Galaxy Health WC |
$473.08
|
| Rate for Payer: Global Benefits Group Commercial |
$333.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$500.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$371.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$344.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.31
|
| Rate for Payer: Multiplan Commercial |
$417.43
|
| Rate for Payer: Networks By Design Commercial |
$361.77
|
| Rate for Payer: Prime Health Services Commercial |
$473.08
|
|
|
HC CATECHOLAMINES UR FRACTIONATED
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.28
|
| Rate for Payer: Blue Shield of California Commercial |
$51.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.74
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.25
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: InnovAge PACE Commercial |
$37.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Medicare |
$26.77
|
| Rate for Payer: Riverside University Health System MISP |
$27.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.46
|
| Rate for Payer: United Healthcare All Other HMO |
$20.46
|
| Rate for Payer: United Healthcare HMO Rider |
$20.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC CATECHOLAMINES UR FRACTIONATED
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC CATECHOLAMINES URINE FRACTIONATED
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900912199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC CATECHOLAMINES URINE FRACTIONATED
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900912199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.28
|
| Rate for Payer: Blue Shield of California Commercial |
$51.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.74
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.25
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: InnovAge PACE Commercial |
$37.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Medicare |
$26.77
|
| Rate for Payer: Riverside University Health System MISP |
$27.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.46
|
| Rate for Payer: United Healthcare All Other HMO |
$20.46
|
| Rate for Payer: United Healthcare HMO Rider |
$20.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC CATH 2 LUMEN 5.5FR 50CM PICC
|
Facility
|
OP
|
$940.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.05 |
| Max. Negotiated Rate |
$846.22 |
| Rate for Payer: Adventist Health Commercial |
$188.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$799.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$517.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$705.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$429.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.61
|
| Rate for Payer: Blue Shield of California Commercial |
$726.81
|
| Rate for Payer: Blue Shield of California EPN |
$473.88
|
| Rate for Payer: Cash Price |
$517.13
|
| Rate for Payer: Central Health Plan Commercial |
$752.19
|
| Rate for Payer: Cigna of CA HMO |
$658.17
|
| Rate for Payer: Cigna of CA PPO |
$658.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$799.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$799.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$799.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.10
|
| Rate for Payer: EPIC Health Plan Senior |
$376.10
|
| Rate for Payer: Galaxy Health WC |
$799.20
|
| Rate for Payer: Global Benefits Group Commercial |
$564.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$846.22
|
| Rate for Payer: InnovAge PACE Commercial |
$470.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$658.17
|
| Rate for Payer: Multiplan Commercial |
$705.18
|
| Rate for Payer: Networks By Design Commercial |
$470.12
|
| Rate for Payer: Prime Health Services Commercial |
$799.20
|
| Rate for Payer: Riverside University Health System MISP |
$376.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.87
|
| Rate for Payer: United Healthcare All Other HMO |
$343.47
|
| Rate for Payer: United Healthcare HMO Rider |
$336.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$307.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$799.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$799.20
|
| Rate for Payer: Vantage Medical Group Senior |
$799.20
|
|
|
HC CATH 2 LUMEN 5.5FR 50CM PICC
|
Facility
|
IP
|
$940.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.05 |
| Max. Negotiated Rate |
$846.22 |
| Rate for Payer: Adventist Health Commercial |
$188.05
|
| Rate for Payer: Blue Shield of California Commercial |
$726.81
|
| Rate for Payer: Blue Shield of California EPN |
$473.88
|
| Rate for Payer: Cash Price |
$517.13
|
| Rate for Payer: Central Health Plan Commercial |
$752.19
|
| Rate for Payer: Cigna of CA HMO |
$658.17
|
| Rate for Payer: Cigna of CA PPO |
$658.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.10
|
| Rate for Payer: EPIC Health Plan Senior |
$376.10
|
| Rate for Payer: Galaxy Health WC |
$799.20
|
| Rate for Payer: Global Benefits Group Commercial |
$564.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$846.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.05
|
| Rate for Payer: Multiplan Commercial |
$705.18
|
| Rate for Payer: Networks By Design Commercial |
$470.12
|
| Rate for Payer: Prime Health Services Commercial |
$799.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.87
|
| Rate for Payer: United Healthcare All Other HMO |
$343.47
|
| Rate for Payer: United Healthcare HMO Rider |
$336.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$307.93
|
|
|
HC CATH 2 LUMEN 5.5FR 55CM PICC
|
Facility
|
OP
|
$940.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.05 |
| Max. Negotiated Rate |
$846.22 |
| Rate for Payer: Adventist Health Commercial |
$188.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$799.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$517.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$705.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$429.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.61
|
| Rate for Payer: Blue Shield of California Commercial |
$726.81
|
| Rate for Payer: Blue Shield of California EPN |
$473.88
|
| Rate for Payer: Cash Price |
$517.13
|
| Rate for Payer: Central Health Plan Commercial |
$752.19
|
| Rate for Payer: Cigna of CA HMO |
$658.17
|
| Rate for Payer: Cigna of CA PPO |
$658.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$799.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$799.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$799.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.10
|
| Rate for Payer: EPIC Health Plan Senior |
$376.10
|
| Rate for Payer: Galaxy Health WC |
$799.20
|
| Rate for Payer: Global Benefits Group Commercial |
$564.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$846.22
|
| Rate for Payer: InnovAge PACE Commercial |
$470.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$658.17
|
| Rate for Payer: Multiplan Commercial |
$705.18
|
| Rate for Payer: Networks By Design Commercial |
$470.12
|
| Rate for Payer: Prime Health Services Commercial |
$799.20
|
| Rate for Payer: Riverside University Health System MISP |
$376.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.87
|
| Rate for Payer: United Healthcare All Other HMO |
$343.47
|
| Rate for Payer: United Healthcare HMO Rider |
$336.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$307.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$799.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$799.20
|
| Rate for Payer: Vantage Medical Group Senior |
$799.20
|
|
|
HC CATH 2 LUMEN 5.5FR 55CM PICC
|
Facility
|
IP
|
$940.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.05 |
| Max. Negotiated Rate |
$846.22 |
| Rate for Payer: Adventist Health Commercial |
$188.05
|
| Rate for Payer: Blue Shield of California Commercial |
$726.81
|
| Rate for Payer: Blue Shield of California EPN |
$473.88
|
| Rate for Payer: Cash Price |
$517.13
|
| Rate for Payer: Central Health Plan Commercial |
$752.19
|
| Rate for Payer: Cigna of CA HMO |
$658.17
|
| Rate for Payer: Cigna of CA PPO |
$658.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.10
|
| Rate for Payer: EPIC Health Plan Senior |
$376.10
|
| Rate for Payer: Galaxy Health WC |
$799.20
|
| Rate for Payer: Global Benefits Group Commercial |
$564.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$846.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.05
|
| Rate for Payer: Multiplan Commercial |
$705.18
|
| Rate for Payer: Networks By Design Commercial |
$470.12
|
| Rate for Payer: Prime Health Services Commercial |
$799.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.87
|
| Rate for Payer: United Healthcare All Other HMO |
$343.47
|
| Rate for Payer: United Healthcare HMO Rider |
$336.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$307.93
|
|
|
HC CATH 3.5FR UMBILICAL 1 LUMEN
|
Facility
|
OP
|
$110.20
|
|
| Hospital Charge Code |
901698606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$99.18 |
| Rate for Payer: Adventist Health Commercial |
$22.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.72
|
| Rate for Payer: Blue Shield of California Commercial |
$67.33
|
| Rate for Payer: Blue Shield of California EPN |
$43.97
|
| Rate for Payer: Cash Price |
$60.61
|
| Rate for Payer: Central Health Plan Commercial |
$88.16
|
| Rate for Payer: Cigna of CA HMO |
$70.53
|
| Rate for Payer: Cigna of CA PPO |
$81.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.08
|
| Rate for Payer: EPIC Health Plan Senior |
$44.08
|
| Rate for Payer: Galaxy Health WC |
$93.67
|
| Rate for Payer: Global Benefits Group Commercial |
$66.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.18
|
| Rate for Payer: InnovAge PACE Commercial |
$55.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.14
|
| Rate for Payer: Multiplan Commercial |
$82.65
|
| Rate for Payer: Networks By Design Commercial |
$71.63
|
| Rate for Payer: Prime Health Services Commercial |
$93.67
|
| Rate for Payer: Riverside University Health System MISP |
$44.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.10
|
| Rate for Payer: United Healthcare All Other HMO |
$55.10
|
| Rate for Payer: United Healthcare HMO Rider |
$55.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.67
|
| Rate for Payer: Vantage Medical Group Senior |
$93.67
|
|
|
HC CATH 3.5FR UMBILICAL 1 LUMEN
|
Facility
|
IP
|
$110.20
|
|
| Hospital Charge Code |
901698606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$99.18 |
| Rate for Payer: Adventist Health Commercial |
$22.04
|
| Rate for Payer: Cash Price |
$60.61
|
| Rate for Payer: Central Health Plan Commercial |
$88.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.08
|
| Rate for Payer: EPIC Health Plan Senior |
$44.08
|
| Rate for Payer: Galaxy Health WC |
$93.67
|
| Rate for Payer: Global Benefits Group Commercial |
$66.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.04
|
| Rate for Payer: Multiplan Commercial |
$82.65
|
| Rate for Payer: Networks By Design Commercial |
$71.63
|
| Rate for Payer: Prime Health Services Commercial |
$93.67
|
|
|
HC CATH 4 LUMEN 8.5FR X 6" PRS INJ
|
Facility
|
IP
|
$580.52
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.10 |
| Max. Negotiated Rate |
$522.47 |
| Rate for Payer: Adventist Health Commercial |
$116.10
|
| Rate for Payer: Blue Shield of California Commercial |
$448.74
|
| Rate for Payer: Blue Shield of California EPN |
$292.58
|
| Rate for Payer: Cash Price |
$319.29
|
| Rate for Payer: Central Health Plan Commercial |
$464.42
|
| Rate for Payer: Cigna of CA HMO |
$406.36
|
| Rate for Payer: Cigna of CA PPO |
$406.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.21
|
| Rate for Payer: EPIC Health Plan Senior |
$232.21
|
| Rate for Payer: Galaxy Health WC |
$493.44
|
| Rate for Payer: Global Benefits Group Commercial |
$348.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$387.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.10
|
| Rate for Payer: Multiplan Commercial |
$435.39
|
| Rate for Payer: Networks By Design Commercial |
$290.26
|
| Rate for Payer: Prime Health Services Commercial |
$493.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.87
|
| Rate for Payer: United Healthcare All Other HMO |
$212.06
|
| Rate for Payer: United Healthcare HMO Rider |
$207.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$190.12
|
|
|
HC CATH 4 LUMEN 8.5FR X 6" PRS INJ
|
Facility
|
OP
|
$580.52
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.10 |
| Max. Negotiated Rate |
$522.47 |
| Rate for Payer: Adventist Health Commercial |
$116.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$265.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.43
|
| Rate for Payer: Blue Shield of California Commercial |
$448.74
|
| Rate for Payer: Blue Shield of California EPN |
$292.58
|
| Rate for Payer: Cash Price |
$319.29
|
| Rate for Payer: Central Health Plan Commercial |
$464.42
|
| Rate for Payer: Cigna of CA HMO |
$406.36
|
| Rate for Payer: Cigna of CA PPO |
$406.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.21
|
| Rate for Payer: EPIC Health Plan Senior |
$232.21
|
| Rate for Payer: Galaxy Health WC |
$493.44
|
| Rate for Payer: Global Benefits Group Commercial |
$348.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.47
|
| Rate for Payer: InnovAge PACE Commercial |
$290.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$387.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.36
|
| Rate for Payer: Multiplan Commercial |
$435.39
|
| Rate for Payer: Networks By Design Commercial |
$290.26
|
| Rate for Payer: Prime Health Services Commercial |
$493.44
|
| Rate for Payer: Riverside University Health System MISP |
$232.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.87
|
| Rate for Payer: United Healthcare All Other HMO |
$212.06
|
| Rate for Payer: United Healthcare HMO Rider |
$207.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$190.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.44
|
| Rate for Payer: Vantage Medical Group Senior |
$493.44
|
|
|
HC CATH ACUTE PERITONEAL DIALYSS
|
Facility
|
IP
|
$990.15
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901602939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.03 |
| Max. Negotiated Rate |
$891.13 |
| Rate for Payer: Adventist Health Commercial |
$198.03
|
| Rate for Payer: Blue Shield of California Commercial |
$765.39
|
| Rate for Payer: Blue Shield of California EPN |
$499.04
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Central Health Plan Commercial |
$792.12
|
| Rate for Payer: Cigna of CA HMO |
$693.11
|
| Rate for Payer: Cigna of CA PPO |
$693.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.06
|
| Rate for Payer: EPIC Health Plan Senior |
$396.06
|
| Rate for Payer: Galaxy Health WC |
$841.63
|
| Rate for Payer: Global Benefits Group Commercial |
$594.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$660.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$612.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.03
|
| Rate for Payer: Multiplan Commercial |
$742.61
|
| Rate for Payer: Networks By Design Commercial |
$495.07
|
| Rate for Payer: Prime Health Services Commercial |
$841.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$371.60
|
| Rate for Payer: United Healthcare All Other HMO |
$361.70
|
| Rate for Payer: United Healthcare HMO Rider |
$353.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.27
|
|
|
HC CATH ACUTE PERITONEAL DIALYSS
|
Facility
|
OP
|
$990.15
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901602939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.03 |
| Max. Negotiated Rate |
$891.13 |
| Rate for Payer: Adventist Health Commercial |
$198.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$841.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$544.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$742.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$452.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$548.25
|
| Rate for Payer: Blue Shield of California Commercial |
$765.39
|
| Rate for Payer: Blue Shield of California EPN |
$499.04
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Central Health Plan Commercial |
$792.12
|
| Rate for Payer: Cigna of CA HMO |
$693.11
|
| Rate for Payer: Cigna of CA PPO |
$693.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$841.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$841.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$841.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.06
|
| Rate for Payer: EPIC Health Plan Senior |
$396.06
|
| Rate for Payer: Galaxy Health WC |
$841.63
|
| Rate for Payer: Global Benefits Group Commercial |
$594.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.13
|
| Rate for Payer: InnovAge PACE Commercial |
$495.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$660.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$612.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$693.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$693.11
|
| Rate for Payer: Multiplan Commercial |
$742.61
|
| Rate for Payer: Networks By Design Commercial |
$495.07
|
| Rate for Payer: Prime Health Services Commercial |
$841.63
|
| Rate for Payer: Riverside University Health System MISP |
$396.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$594.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$594.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$371.60
|
| Rate for Payer: United Healthcare All Other HMO |
$361.70
|
| Rate for Payer: United Healthcare HMO Rider |
$353.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$841.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$841.63
|
| Rate for Payer: Vantage Medical Group Senior |
$841.63
|
|
|
HC CATH AGA EXCHANGE SYS
|
Facility
|
IP
|
$2,355.60
|
|
| Hospital Charge Code |
906812241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.12 |
| Max. Negotiated Rate |
$2,120.04 |
| Rate for Payer: Adventist Health Commercial |
$471.12
|
| Rate for Payer: Cash Price |
$1,295.58
|
| Rate for Payer: Central Health Plan Commercial |
$1,884.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$942.24
|
| Rate for Payer: EPIC Health Plan Senior |
$942.24
|
| Rate for Payer: Galaxy Health WC |
$2,002.26
|
| Rate for Payer: Global Benefits Group Commercial |
$1,413.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,120.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,571.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$897.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,458.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.12
|
| Rate for Payer: Multiplan Commercial |
$1,766.70
|
| Rate for Payer: Networks By Design Commercial |
$1,531.14
|
| Rate for Payer: Prime Health Services Commercial |
$2,002.26
|
|
|
HC CATH AGA EXCHANGE SYS
|
Facility
|
OP
|
$2,355.60
|
|
| Hospital Charge Code |
906812241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.12 |
| Max. Negotiated Rate |
$2,120.04 |
| Rate for Payer: Adventist Health Commercial |
$471.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,430.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,002.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,295.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,766.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,140.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,383.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,439.27
|
| Rate for Payer: Blue Shield of California EPN |
$939.88
|
| Rate for Payer: Cash Price |
$1,295.58
|
| Rate for Payer: Central Health Plan Commercial |
$1,884.48
|
| Rate for Payer: Cigna of CA HMO |
$1,507.58
|
| Rate for Payer: Cigna of CA PPO |
$1,743.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,002.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,002.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,002.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$942.24
|
| Rate for Payer: EPIC Health Plan Senior |
$942.24
|
| Rate for Payer: Galaxy Health WC |
$2,002.26
|
| Rate for Payer: Global Benefits Group Commercial |
$1,413.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,120.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,571.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$897.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,458.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,648.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,648.92
|
| Rate for Payer: Multiplan Commercial |
$1,766.70
|
| Rate for Payer: Networks By Design Commercial |
$1,531.14
|
| Rate for Payer: Prime Health Services Commercial |
$2,002.26
|
| Rate for Payer: Riverside University Health System MISP |
$942.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,413.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,413.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,177.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1,177.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1,177.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,177.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,002.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,002.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,002.26
|
|
|
HC CATH AIRWAY EXCHANGE 11FR
|
Facility
|
OP
|
$392.25
|
|
| Hospital Charge Code |
901603694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$353.02 |
| Rate for Payer: Adventist Health Commercial |
$78.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$333.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.37
|
| Rate for Payer: Blue Shield of California Commercial |
$239.66
|
| Rate for Payer: Blue Shield of California EPN |
$156.51
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Central Health Plan Commercial |
$313.80
|
| Rate for Payer: Cigna of CA HMO |
$251.04
|
| Rate for Payer: Cigna of CA PPO |
$290.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$333.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$333.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$333.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.90
|
| Rate for Payer: EPIC Health Plan Senior |
$156.90
|
| Rate for Payer: Galaxy Health WC |
$333.41
|
| Rate for Payer: Global Benefits Group Commercial |
$235.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.02
|
| Rate for Payer: InnovAge PACE Commercial |
$196.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.57
|
| Rate for Payer: Multiplan Commercial |
$294.19
|
| Rate for Payer: Networks By Design Commercial |
$254.96
|
| Rate for Payer: Prime Health Services Commercial |
$333.41
|
| Rate for Payer: Riverside University Health System MISP |
$156.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.12
|
| Rate for Payer: United Healthcare All Other HMO |
$196.12
|
| Rate for Payer: United Healthcare HMO Rider |
$196.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$333.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$333.41
|
| Rate for Payer: Vantage Medical Group Senior |
$333.41
|
|
|
HC CATH AIRWAY EXCHANGE 11FR
|
Facility
|
IP
|
$392.25
|
|
| Hospital Charge Code |
901603694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$353.02 |
| Rate for Payer: Adventist Health Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Central Health Plan Commercial |
$313.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.90
|
| Rate for Payer: EPIC Health Plan Senior |
$156.90
|
| Rate for Payer: Galaxy Health WC |
$333.41
|
| Rate for Payer: Global Benefits Group Commercial |
$235.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.45
|
| Rate for Payer: Multiplan Commercial |
$294.19
|
| Rate for Payer: Networks By Design Commercial |
$254.96
|
| Rate for Payer: Prime Health Services Commercial |
$333.41
|
|
