|
HC CATH MAHURKAR 10FR 12MM DBL
|
Facility
|
IP
|
$446.89
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$402.20 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Blue Shield of California Commercial |
$358.41
|
| Rate for Payer: Blue Shield of California EPN |
$225.23
|
| Rate for Payer: Cash Price |
$201.10
|
| Rate for Payer: Central Health Plan Commercial |
$357.51
|
| Rate for Payer: Cigna of CA HMO |
$312.82
|
| Rate for Payer: Cigna of CA PPO |
$312.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$312.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.76
|
| Rate for Payer: EPIC Health Plan Senior |
$178.76
|
| Rate for Payer: Galaxy Health WC |
$379.86
|
| Rate for Payer: Global Benefits Group Commercial |
$268.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$402.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$283.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$263.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.38
|
| Rate for Payer: Multiplan Commercial |
$335.17
|
| Rate for Payer: Networks By Design Commercial |
$223.44
|
| Rate for Payer: Prime Health Services Commercial |
$379.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.72
|
| Rate for Payer: United Healthcare All Other HMO |
$163.25
|
| Rate for Payer: United Healthcare HMO Rider |
$159.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.36
|
|
|
HC CATH MAHURKAR 11.5FR 13.5 CM
|
Facility
|
OP
|
$447.76
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$402.98 |
| Rate for Payer: Adventist Health Commercial |
$89.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$204.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.55
|
| Rate for Payer: Blue Shield of California Commercial |
$359.10
|
| Rate for Payer: Blue Shield of California EPN |
$225.67
|
| Rate for Payer: Cash Price |
$201.49
|
| Rate for Payer: Central Health Plan Commercial |
$358.21
|
| Rate for Payer: Cigna of CA HMO |
$313.43
|
| Rate for Payer: Cigna of CA PPO |
$313.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$380.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.10
|
| Rate for Payer: EPIC Health Plan Senior |
$179.10
|
| Rate for Payer: Galaxy Health WC |
$380.60
|
| Rate for Payer: Global Benefits Group Commercial |
$268.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$402.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$313.43
|
| Rate for Payer: Multiplan Commercial |
$335.82
|
| Rate for Payer: Networks By Design Commercial |
$223.88
|
| Rate for Payer: Prime Health Services Commercial |
$380.60
|
| Rate for Payer: Riverside University Health System MISP |
$179.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.04
|
| Rate for Payer: United Healthcare All Other HMO |
$163.57
|
| Rate for Payer: United Healthcare HMO Rider |
$160.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.60
|
| Rate for Payer: Vantage Medical Group Senior |
$380.60
|
|
|
HC CATH MAHURKAR 11.5FR 13.5 CM
|
Facility
|
IP
|
$447.76
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$402.98 |
| Rate for Payer: Adventist Health Commercial |
$89.55
|
| Rate for Payer: Blue Shield of California Commercial |
$359.10
|
| Rate for Payer: Blue Shield of California EPN |
$225.67
|
| Rate for Payer: Cash Price |
$201.49
|
| Rate for Payer: Central Health Plan Commercial |
$358.21
|
| Rate for Payer: Cigna of CA HMO |
$313.43
|
| Rate for Payer: Cigna of CA PPO |
$313.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.10
|
| Rate for Payer: EPIC Health Plan Senior |
$179.10
|
| Rate for Payer: Galaxy Health WC |
$380.60
|
| Rate for Payer: Global Benefits Group Commercial |
$268.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$402.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.55
|
| Rate for Payer: Multiplan Commercial |
$335.82
|
| Rate for Payer: Networks By Design Commercial |
$223.88
|
| Rate for Payer: Prime Health Services Commercial |
$380.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.04
|
| Rate for Payer: United Healthcare All Other HMO |
$163.57
|
| Rate for Payer: United Healthcare HMO Rider |
$160.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.64
|
|
|
HC CATH MAHURKAR 11.5FR 19.5 CM
|
Facility
|
IP
|
$479.14
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.83 |
| Max. Negotiated Rate |
$431.23 |
| Rate for Payer: Adventist Health Commercial |
$95.83
|
| Rate for Payer: Blue Shield of California Commercial |
$384.27
|
| Rate for Payer: Blue Shield of California EPN |
$241.49
|
| Rate for Payer: Cash Price |
$215.61
|
| Rate for Payer: Central Health Plan Commercial |
$383.31
|
| Rate for Payer: Cigna of CA HMO |
$335.40
|
| Rate for Payer: Cigna of CA PPO |
$335.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$335.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.66
|
| Rate for Payer: EPIC Health Plan Senior |
$191.66
|
| Rate for Payer: Galaxy Health WC |
$407.27
|
| Rate for Payer: Global Benefits Group Commercial |
$287.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.83
|
| Rate for Payer: Multiplan Commercial |
$359.36
|
| Rate for Payer: Networks By Design Commercial |
$239.57
|
| Rate for Payer: Prime Health Services Commercial |
$407.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.82
|
| Rate for Payer: United Healthcare All Other HMO |
$175.03
|
| Rate for Payer: United Healthcare HMO Rider |
$171.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.92
|
|
|
HC CATH MAHURKAR 11.5FR 19.5 CM
|
Facility
|
OP
|
$479.14
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.83 |
| Max. Negotiated Rate |
$431.23 |
| Rate for Payer: Adventist Health Commercial |
$95.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$407.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.76
|
| Rate for Payer: Blue Shield of California Commercial |
$384.27
|
| Rate for Payer: Blue Shield of California EPN |
$241.49
|
| Rate for Payer: Cash Price |
$215.61
|
| Rate for Payer: Central Health Plan Commercial |
$383.31
|
| Rate for Payer: Cigna of CA HMO |
$335.40
|
| Rate for Payer: Cigna of CA PPO |
$335.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$407.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$335.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.66
|
| Rate for Payer: EPIC Health Plan Senior |
$191.66
|
| Rate for Payer: Galaxy Health WC |
$407.27
|
| Rate for Payer: Global Benefits Group Commercial |
$287.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$335.40
|
| Rate for Payer: Multiplan Commercial |
$359.36
|
| Rate for Payer: Networks By Design Commercial |
$239.57
|
| Rate for Payer: Prime Health Services Commercial |
$407.27
|
| Rate for Payer: Riverside University Health System MISP |
$191.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.82
|
| Rate for Payer: United Healthcare All Other HMO |
$175.03
|
| Rate for Payer: United Healthcare HMO Rider |
$171.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$407.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.27
|
| Rate for Payer: Vantage Medical Group Senior |
$407.27
|
|
|
HC CATH MAHURKAR 12FR X 13CM
|
Facility
|
IP
|
$576.93
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.39 |
| Max. Negotiated Rate |
$519.24 |
| Rate for Payer: Adventist Health Commercial |
$115.39
|
| Rate for Payer: Blue Shield of California Commercial |
$462.70
|
| Rate for Payer: Blue Shield of California EPN |
$290.77
|
| Rate for Payer: Cash Price |
$259.62
|
| Rate for Payer: Central Health Plan Commercial |
$461.54
|
| Rate for Payer: Cigna of CA HMO |
$403.85
|
| Rate for Payer: Cigna of CA PPO |
$403.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$403.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.77
|
| Rate for Payer: EPIC Health Plan Senior |
$230.77
|
| Rate for Payer: Galaxy Health WC |
$490.39
|
| Rate for Payer: Global Benefits Group Commercial |
$346.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$366.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$340.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.39
|
| Rate for Payer: Multiplan Commercial |
$432.70
|
| Rate for Payer: Networks By Design Commercial |
$288.46
|
| Rate for Payer: Prime Health Services Commercial |
$490.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.52
|
| Rate for Payer: United Healthcare All Other HMO |
$210.75
|
| Rate for Payer: United Healthcare HMO Rider |
$206.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.94
|
|
|
HC CATH MAHURKAR 12FR X 13CM
|
Facility
|
OP
|
$576.93
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.39 |
| Max. Negotiated Rate |
$519.24 |
| Rate for Payer: Adventist Health Commercial |
$115.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$263.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.39
|
| Rate for Payer: Blue Shield of California Commercial |
$462.70
|
| Rate for Payer: Blue Shield of California EPN |
$290.77
|
| Rate for Payer: Cash Price |
$259.62
|
| Rate for Payer: Central Health Plan Commercial |
$461.54
|
| Rate for Payer: Cigna of CA HMO |
$403.85
|
| Rate for Payer: Cigna of CA PPO |
$403.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$403.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.77
|
| Rate for Payer: EPIC Health Plan Senior |
$230.77
|
| Rate for Payer: Galaxy Health WC |
$490.39
|
| Rate for Payer: Global Benefits Group Commercial |
$346.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$366.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$340.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$403.85
|
| Rate for Payer: Multiplan Commercial |
$432.70
|
| Rate for Payer: Networks By Design Commercial |
$288.46
|
| Rate for Payer: Prime Health Services Commercial |
$490.39
|
| Rate for Payer: Riverside University Health System MISP |
$230.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.52
|
| Rate for Payer: United Healthcare All Other HMO |
$210.75
|
| Rate for Payer: United Healthcare HMO Rider |
$206.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.39
|
| Rate for Payer: Vantage Medical Group Senior |
$490.39
|
|
|
HC CATH MAHURKAR TL ST 12FR 16CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$465.16
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| 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 |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC CATH MAHURKAR TL ST 12FR 16CM
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| 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 |
$264.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.07
|
| Rate for Payer: Blue Shield of California Commercial |
$465.16
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| 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 |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| 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 CATH MAHURKAR TL ST 12FR 20CM
|
Facility
|
IP
|
$584.57
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.91 |
| Max. Negotiated Rate |
$526.11 |
| Rate for Payer: Adventist Health Commercial |
$116.91
|
| Rate for Payer: Blue Shield of California Commercial |
$468.83
|
| Rate for Payer: Blue Shield of California EPN |
$294.62
|
| Rate for Payer: Cash Price |
$263.06
|
| Rate for Payer: Central Health Plan Commercial |
$467.66
|
| Rate for Payer: Cigna of CA HMO |
$409.20
|
| Rate for Payer: Cigna of CA PPO |
$409.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$409.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.83
|
| Rate for Payer: EPIC Health Plan Senior |
$233.83
|
| Rate for Payer: Galaxy Health WC |
$496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$350.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$371.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$344.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.91
|
| Rate for Payer: Multiplan Commercial |
$438.43
|
| Rate for Payer: Networks By Design Commercial |
$292.29
|
| Rate for Payer: Prime Health Services Commercial |
$496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.39
|
| Rate for Payer: United Healthcare All Other HMO |
$213.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.45
|
|
|
HC CATH MAHURKAR TL ST 12FR 20CM
|
Facility
|
OP
|
$584.57
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.91 |
| Max. Negotiated Rate |
$526.11 |
| Rate for Payer: Adventist Health Commercial |
$116.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$438.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.58
|
| Rate for Payer: Blue Shield of California Commercial |
$468.83
|
| Rate for Payer: Blue Shield of California EPN |
$294.62
|
| Rate for Payer: Cash Price |
$263.06
|
| Rate for Payer: Central Health Plan Commercial |
$467.66
|
| Rate for Payer: Cigna of CA HMO |
$409.20
|
| Rate for Payer: Cigna of CA PPO |
$409.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$409.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.83
|
| Rate for Payer: EPIC Health Plan Senior |
$233.83
|
| Rate for Payer: Galaxy Health WC |
$496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$350.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$371.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$344.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$409.20
|
| Rate for Payer: Multiplan Commercial |
$438.43
|
| Rate for Payer: Networks By Design Commercial |
$292.29
|
| Rate for Payer: Prime Health Services Commercial |
$496.88
|
| Rate for Payer: Riverside University Health System MISP |
$233.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$350.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.39
|
| Rate for Payer: United Healthcare All Other HMO |
$213.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$496.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.88
|
| Rate for Payer: Vantage Medical Group Senior |
$496.88
|
|
|
HC CATH MALE EXT .21MM SPORT
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.35
|
| Rate for Payer: Cigna of CA PPO |
$6.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Riverside University Health System MISP |
$3.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
HC CATH MALE EXT .21MM SPORT
|
Facility
|
IP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC CATH MALE EXT .25MM SPORT
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.35
|
| Rate for Payer: Cigna of CA PPO |
$6.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Riverside University Health System MISP |
$3.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
HC CATH MALE EXT .25MM SPORT
|
Facility
|
IP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC CATH MALE EXT .25MM STANDARD
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
|
|
HC CATH MALE EXT .25MM STANDARD
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: Cigna of CA HMO |
$5.30
|
| Rate for Payer: Cigna of CA PPO |
$6.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
| Rate for Payer: Riverside University Health System MISP |
$3.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.04
|
|
|
HC CATH MALE EXT .28MM STANDARD
|
Facility
|
IP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC CATH MALE EXT .28MM STANDARD
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.35
|
| Rate for Payer: Cigna of CA PPO |
$6.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Riverside University Health System MISP |
$3.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
HC CATH MALE EXT .30MM SPORT
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.35
|
| Rate for Payer: Cigna of CA PPO |
$6.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Riverside University Health System MISP |
$3.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
HC CATH MALE EXT .30MM SPORT
|
Facility
|
IP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC CATH MALE EXT .30MM STANDARD
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
|
|
HC CATH MALE EXT .30MM STANDARD
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: Cigna of CA HMO |
$5.30
|
| Rate for Payer: Cigna of CA PPO |
$6.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
| Rate for Payer: Riverside University Health System MISP |
$3.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.04
|
|
|
HC CATH MALE EXT .35MM SPORT
|
Facility
|
IP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC CATH MALE EXT .35MM SPORT
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.35
|
| Rate for Payer: Cigna of CA PPO |
$6.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Riverside University Health System MISP |
$3.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
