|
HC CATH MIDLINE KIT 4.5FRX15CM
|
Facility
|
OP
|
$829.89
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$746.90 |
| Rate for Payer: Adventist Health Commercial |
$165.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$705.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$622.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$378.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$455.11
|
| Rate for Payer: Blue Shield of California Commercial |
$665.57
|
| Rate for Payer: Blue Shield of California EPN |
$418.26
|
| Rate for Payer: Cash Price |
$373.45
|
| Rate for Payer: Central Health Plan Commercial |
$663.91
|
| Rate for Payer: Cigna of CA HMO |
$580.92
|
| Rate for Payer: Cigna of CA PPO |
$580.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$705.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$705.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$705.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$580.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.96
|
| Rate for Payer: EPIC Health Plan Senior |
$331.96
|
| Rate for Payer: Galaxy Health WC |
$705.41
|
| Rate for Payer: Global Benefits Group Commercial |
$497.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$746.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$526.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$489.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$580.92
|
| Rate for Payer: Multiplan Commercial |
$622.42
|
| Rate for Payer: Networks By Design Commercial |
$414.94
|
| Rate for Payer: Prime Health Services Commercial |
$705.41
|
| Rate for Payer: Riverside University Health System MISP |
$331.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$497.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$497.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$311.46
|
| Rate for Payer: United Healthcare All Other HMO |
$303.16
|
| Rate for Payer: United Healthcare HMO Rider |
$296.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$705.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$705.41
|
| Rate for Payer: Vantage Medical Group Senior |
$705.41
|
|
|
HC CATH MIDLINE KIT 5.5FR X 15CM
|
Facility
|
IP
|
$890.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.05 |
| Max. Negotiated Rate |
$801.22 |
| Rate for Payer: Adventist Health Commercial |
$178.05
|
| Rate for Payer: Blue Shield of California Commercial |
$713.97
|
| Rate for Payer: Blue Shield of California EPN |
$448.68
|
| Rate for Payer: Cash Price |
$400.61
|
| Rate for Payer: Central Health Plan Commercial |
$712.19
|
| Rate for Payer: Cigna of CA HMO |
$623.17
|
| Rate for Payer: Cigna of CA PPO |
$623.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$623.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.10
|
| Rate for Payer: EPIC Health Plan Senior |
$356.10
|
| Rate for Payer: Galaxy Health WC |
$756.70
|
| Rate for Payer: Global Benefits Group Commercial |
$534.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$565.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.05
|
| Rate for Payer: Multiplan Commercial |
$667.68
|
| Rate for Payer: Networks By Design Commercial |
$445.12
|
| Rate for Payer: Prime Health Services Commercial |
$756.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.11
|
| Rate for Payer: United Healthcare All Other HMO |
$325.20
|
| Rate for Payer: United Healthcare HMO Rider |
$318.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.55
|
|
|
HC CATH MIDLINE KIT 5.5FR X 15CM
|
Facility
|
OP
|
$890.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.05 |
| Max. Negotiated Rate |
$801.22 |
| Rate for Payer: Adventist Health Commercial |
$178.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$756.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$489.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$667.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$488.21
|
| Rate for Payer: Blue Shield of California Commercial |
$713.97
|
| Rate for Payer: Blue Shield of California EPN |
$448.68
|
| Rate for Payer: Cash Price |
$400.61
|
| Rate for Payer: Central Health Plan Commercial |
$712.19
|
| Rate for Payer: Cigna of CA HMO |
$623.17
|
| Rate for Payer: Cigna of CA PPO |
$623.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$756.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$756.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$623.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.10
|
| Rate for Payer: EPIC Health Plan Senior |
$356.10
|
| Rate for Payer: Galaxy Health WC |
$756.70
|
| Rate for Payer: Global Benefits Group Commercial |
$534.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$565.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$323.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$623.17
|
| Rate for Payer: Multiplan Commercial |
$667.68
|
| Rate for Payer: Networks By Design Commercial |
$445.12
|
| Rate for Payer: Prime Health Services Commercial |
$756.70
|
| Rate for Payer: Riverside University Health System MISP |
$356.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.11
|
| Rate for Payer: United Healthcare All Other HMO |
$325.20
|
| Rate for Payer: United Healthcare HMO Rider |
$318.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$756.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.70
|
| Rate for Payer: Vantage Medical Group Senior |
$756.70
|
|
|
HC CATH MIDLINE KIT 5.5FRX15CM
|
Facility
|
IP
|
$908.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.70 |
| Max. Negotiated Rate |
$817.65 |
| Rate for Payer: Adventist Health Commercial |
$181.70
|
| Rate for Payer: Blue Shield of California Commercial |
$728.62
|
| Rate for Payer: Blue Shield of California EPN |
$457.88
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Central Health Plan Commercial |
$726.80
|
| Rate for Payer: Cigna of CA HMO |
$635.95
|
| Rate for Payer: Cigna of CA PPO |
$635.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$635.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.40
|
| Rate for Payer: EPIC Health Plan Senior |
$363.40
|
| Rate for Payer: Galaxy Health WC |
$772.23
|
| Rate for Payer: Global Benefits Group Commercial |
$545.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$576.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.70
|
| Rate for Payer: Multiplan Commercial |
$681.38
|
| Rate for Payer: Networks By Design Commercial |
$454.25
|
| Rate for Payer: Prime Health Services Commercial |
$772.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.96
|
| Rate for Payer: United Healthcare All Other HMO |
$331.88
|
| Rate for Payer: United Healthcare HMO Rider |
$324.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.53
|
|
|
HC CATH MIDLINE KIT 5.5FRX15CM
|
Facility
|
OP
|
$908.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.70 |
| Max. Negotiated Rate |
$817.65 |
| Rate for Payer: Adventist Health Commercial |
$181.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$681.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$414.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.22
|
| Rate for Payer: Blue Shield of California Commercial |
$728.62
|
| Rate for Payer: Blue Shield of California EPN |
$457.88
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Central Health Plan Commercial |
$726.80
|
| Rate for Payer: Cigna of CA HMO |
$635.95
|
| Rate for Payer: Cigna of CA PPO |
$635.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$772.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$635.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.40
|
| Rate for Payer: EPIC Health Plan Senior |
$363.40
|
| Rate for Payer: Galaxy Health WC |
$772.23
|
| Rate for Payer: Global Benefits Group Commercial |
$545.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$576.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$329.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$635.95
|
| Rate for Payer: Multiplan Commercial |
$681.38
|
| Rate for Payer: Networks By Design Commercial |
$454.25
|
| Rate for Payer: Prime Health Services Commercial |
$772.23
|
| Rate for Payer: Riverside University Health System MISP |
$363.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$545.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$545.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.96
|
| Rate for Payer: United Healthcare All Other HMO |
$331.88
|
| Rate for Payer: United Healthcare HMO Rider |
$324.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.23
|
| Rate for Payer: Vantage Medical Group Senior |
$772.23
|
|
|
HC CATH MILLAR MICRO TIP SPC-320
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
906812398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC CATH MILLAR MICRO TIP SPC-320
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
906812398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,337.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,458.20
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$834.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC CATH PACING ELECTRODE 5FR
|
Facility
|
IP
|
$1,162.19
|
|
| Hospital Charge Code |
901607263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$1,045.97 |
| Rate for Payer: Adventist Health Commercial |
$232.44
|
| Rate for Payer: Cash Price |
$522.99
|
| Rate for Payer: Central Health Plan Commercial |
$929.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$813.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.88
|
| Rate for Payer: EPIC Health Plan Senior |
$464.88
|
| Rate for Payer: Galaxy Health WC |
$987.86
|
| Rate for Payer: Global Benefits Group Commercial |
$697.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,045.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$737.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$685.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.44
|
| Rate for Payer: Multiplan Commercial |
$871.64
|
| Rate for Payer: Networks By Design Commercial |
$755.42
|
| Rate for Payer: Prime Health Services Commercial |
$987.86
|
|
|
HC CATH PACING ELECTRODE 5FR
|
Facility
|
OP
|
$1,162.19
|
|
| Hospital Charge Code |
901607263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$1,045.97 |
| Rate for Payer: Adventist Health Commercial |
$232.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$705.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$987.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$639.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$871.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$562.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$676.05
|
| Rate for Payer: Blue Shield of California Commercial |
$736.83
|
| Rate for Payer: Blue Shield of California EPN |
$463.71
|
| Rate for Payer: Cash Price |
$522.99
|
| Rate for Payer: Central Health Plan Commercial |
$929.75
|
| Rate for Payer: Cigna of CA HMO |
$743.80
|
| Rate for Payer: Cigna of CA PPO |
$860.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$987.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$987.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$987.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$813.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.88
|
| Rate for Payer: EPIC Health Plan Senior |
$464.88
|
| Rate for Payer: Galaxy Health WC |
$987.86
|
| Rate for Payer: Global Benefits Group Commercial |
$697.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,045.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$737.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$421.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$685.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$813.53
|
| Rate for Payer: Multiplan Commercial |
$871.64
|
| Rate for Payer: Networks By Design Commercial |
$755.42
|
| Rate for Payer: Prime Health Services Commercial |
$987.86
|
| Rate for Payer: Riverside University Health System MISP |
$464.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$697.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$697.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.10
|
| Rate for Payer: United Healthcare All Other HMO |
$581.10
|
| Rate for Payer: United Healthcare HMO Rider |
$581.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$987.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$987.86
|
| Rate for Payer: Vantage Medical Group Senior |
$987.86
|
|
|
HC CATH PEDS 10FR 3ML W 5ML SW
|
Facility
|
IP
|
$45.43
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
901607517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$40.89 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Cash Price |
$20.44
|
| Rate for Payer: Central Health Plan Commercial |
$36.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.17
|
| Rate for Payer: EPIC Health Plan Senior |
$18.17
|
| Rate for Payer: Galaxy Health WC |
$38.62
|
| Rate for Payer: Global Benefits Group Commercial |
$27.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$34.07
|
| Rate for Payer: Networks By Design Commercial |
$29.53
|
| Rate for Payer: Prime Health Services Commercial |
$38.62
|
|
|
HC CATH PEDS 10FR 3ML W 5ML SW
|
Facility
|
OP
|
$45.43
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
901607517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$40.89 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.43
|
| Rate for Payer: Blue Shield of California Commercial |
$28.80
|
| Rate for Payer: Blue Shield of California EPN |
$18.13
|
| Rate for Payer: Cash Price |
$20.44
|
| Rate for Payer: Cash Price |
$20.44
|
| Rate for Payer: Central Health Plan Commercial |
$36.34
|
| Rate for Payer: Cigna of CA HMO |
$29.08
|
| Rate for Payer: Cigna of CA PPO |
$33.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.17
|
| Rate for Payer: EPIC Health Plan Senior |
$18.17
|
| Rate for Payer: Galaxy Health WC |
$38.62
|
| Rate for Payer: Global Benefits Group Commercial |
$27.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.80
|
| Rate for Payer: Multiplan Commercial |
$34.07
|
| Rate for Payer: Networks By Design Commercial |
$29.53
|
| Rate for Payer: Prime Health Services Commercial |
$38.62
|
| Rate for Payer: Riverside University Health System MISP |
$18.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.71
|
| Rate for Payer: United Healthcare All Other HMO |
$22.71
|
| Rate for Payer: United Healthcare HMO Rider |
$22.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.62
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
|
|
HC CATH PEDS 8FR 3ML W 5ML SW
|
Facility
|
IP
|
$49.12
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
901607396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$44.21 |
| Rate for Payer: Adventist Health Commercial |
$9.82
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Central Health Plan Commercial |
$39.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.65
|
| Rate for Payer: EPIC Health Plan Senior |
$19.65
|
| Rate for Payer: Galaxy Health WC |
$41.75
|
| Rate for Payer: Global Benefits Group Commercial |
$29.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.82
|
| Rate for Payer: Multiplan Commercial |
$36.84
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$41.75
|
|
|
HC CATH PEDS 8FR 3ML W 5ML SW
|
Facility
|
OP
|
$49.12
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
901607396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$44.21 |
| Rate for Payer: Adventist Health Commercial |
$9.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.57
|
| Rate for Payer: Blue Shield of California Commercial |
$31.14
|
| Rate for Payer: Blue Shield of California EPN |
$19.60
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Central Health Plan Commercial |
$39.30
|
| Rate for Payer: Cigna of CA HMO |
$31.44
|
| Rate for Payer: Cigna of CA PPO |
$36.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.65
|
| Rate for Payer: EPIC Health Plan Senior |
$19.65
|
| Rate for Payer: Galaxy Health WC |
$41.75
|
| Rate for Payer: Global Benefits Group Commercial |
$29.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.38
|
| Rate for Payer: Multiplan Commercial |
$36.84
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$41.75
|
| Rate for Payer: Riverside University Health System MISP |
$19.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.56
|
| Rate for Payer: United Healthcare All Other HMO |
$24.56
|
| Rate for Payer: United Healthcare HMO Rider |
$24.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.75
|
| Rate for Payer: Vantage Medical Group Senior |
$41.75
|
|
|
HC CATH PEDS FOLEY TRAY 10FR 5ML
|
Facility
|
OP
|
$226.45
|
|
| Hospital Charge Code |
901698909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$203.81 |
| Rate for Payer: Adventist Health Commercial |
$45.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.73
|
| Rate for Payer: Blue Shield of California Commercial |
$143.57
|
| Rate for Payer: Blue Shield of California EPN |
$90.35
|
| Rate for Payer: Cash Price |
$101.90
|
| Rate for Payer: Central Health Plan Commercial |
$181.16
|
| Rate for Payer: Cigna of CA HMO |
$144.93
|
| Rate for Payer: Cigna of CA PPO |
$167.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.58
|
| Rate for Payer: EPIC Health Plan Senior |
$90.58
|
| Rate for Payer: Galaxy Health WC |
$192.48
|
| Rate for Payer: Global Benefits Group Commercial |
$135.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$158.51
|
| Rate for Payer: Multiplan Commercial |
$169.84
|
| Rate for Payer: Networks By Design Commercial |
$147.19
|
| Rate for Payer: Prime Health Services Commercial |
$192.48
|
| Rate for Payer: Riverside University Health System MISP |
$90.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.22
|
| Rate for Payer: United Healthcare All Other HMO |
$113.22
|
| Rate for Payer: United Healthcare HMO Rider |
$113.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.48
|
| Rate for Payer: Vantage Medical Group Senior |
$192.48
|
|
|
HC CATH PEDS FOLEY TRAY 10FR 5ML
|
Facility
|
IP
|
$226.45
|
|
| Hospital Charge Code |
901698909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$203.81 |
| Rate for Payer: Adventist Health Commercial |
$45.29
|
| Rate for Payer: Cash Price |
$101.90
|
| Rate for Payer: Central Health Plan Commercial |
$181.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.58
|
| Rate for Payer: EPIC Health Plan Senior |
$90.58
|
| Rate for Payer: Galaxy Health WC |
$192.48
|
| Rate for Payer: Global Benefits Group Commercial |
$135.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.29
|
| Rate for Payer: Multiplan Commercial |
$169.84
|
| Rate for Payer: Networks By Design Commercial |
$147.19
|
| Rate for Payer: Prime Health Services Commercial |
$192.48
|
|
|
HC CATH PEDS FOLEY TRAY 8FR 3ML
|
Facility
|
OP
|
$202.86
|
|
| Hospital Charge Code |
901698910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$182.57 |
| Rate for Payer: Adventist Health Commercial |
$40.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.00
|
| Rate for Payer: Blue Shield of California Commercial |
$128.61
|
| Rate for Payer: Blue Shield of California EPN |
$80.94
|
| Rate for Payer: Cash Price |
$91.29
|
| Rate for Payer: Central Health Plan Commercial |
$162.29
|
| Rate for Payer: Cigna of CA HMO |
$129.83
|
| Rate for Payer: Cigna of CA PPO |
$150.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.14
|
| Rate for Payer: EPIC Health Plan Senior |
$81.14
|
| Rate for Payer: Galaxy Health WC |
$172.43
|
| Rate for Payer: Global Benefits Group Commercial |
$121.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$152.15
|
| Rate for Payer: Networks By Design Commercial |
$131.86
|
| Rate for Payer: Prime Health Services Commercial |
$172.43
|
| Rate for Payer: Riverside University Health System MISP |
$81.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.43
|
| Rate for Payer: United Healthcare All Other HMO |
$101.43
|
| Rate for Payer: United Healthcare HMO Rider |
$101.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.43
|
| Rate for Payer: Vantage Medical Group Senior |
$172.43
|
|
|
HC CATH PEDS FOLEY TRAY 8FR 3ML
|
Facility
|
IP
|
$202.86
|
|
| Hospital Charge Code |
901698910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$182.57 |
| Rate for Payer: Adventist Health Commercial |
$40.57
|
| Rate for Payer: Cash Price |
$91.29
|
| Rate for Payer: Central Health Plan Commercial |
$162.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.14
|
| Rate for Payer: EPIC Health Plan Senior |
$81.14
|
| Rate for Payer: Galaxy Health WC |
$172.43
|
| Rate for Payer: Global Benefits Group Commercial |
$121.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.57
|
| Rate for Payer: Multiplan Commercial |
$152.15
|
| Rate for Payer: Networks By Design Commercial |
$131.86
|
| Rate for Payer: Prime Health Services Commercial |
$172.43
|
|
|
HC CATH PENUMBRA 3D STNT RTRVR
|
Facility
|
IP
|
$17,156.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909011757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.20 |
| Max. Negotiated Rate |
$15,440.40 |
| Rate for Payer: Adventist Health Commercial |
$3,431.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13,759.11
|
| Rate for Payer: Blue Shield of California EPN |
$8,646.62
|
| Rate for Payer: Cash Price |
$7,720.20
|
| Rate for Payer: Central Health Plan Commercial |
$13,724.80
|
| Rate for Payer: Cigna of CA HMO |
$12,009.20
|
| Rate for Payer: Cigna of CA PPO |
$12,009.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,009.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,862.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,862.40
|
| Rate for Payer: Galaxy Health WC |
$14,582.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,293.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,440.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,894.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,122.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,431.20
|
| Rate for Payer: Multiplan Commercial |
$12,867.00
|
| Rate for Payer: Networks By Design Commercial |
$8,578.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,582.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,438.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6,267.09
|
| Rate for Payer: United Healthcare HMO Rider |
$6,131.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,618.59
|
|
|
HC CATH PENUMBRA 3D STNT RTRVR
|
Facility
|
OP
|
$17,156.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909011757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.20 |
| Max. Negotiated Rate |
$15,440.40 |
| Rate for Payer: Adventist Health Commercial |
$3,431.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,435.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,867.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,833.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,408.35
|
| Rate for Payer: Blue Shield of California Commercial |
$13,759.11
|
| Rate for Payer: Blue Shield of California EPN |
$8,646.62
|
| Rate for Payer: Cash Price |
$7,720.20
|
| Rate for Payer: Central Health Plan Commercial |
$13,724.80
|
| Rate for Payer: Cigna of CA HMO |
$12,009.20
|
| Rate for Payer: Cigna of CA PPO |
$12,009.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,582.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,582.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,009.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,862.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,862.40
|
| Rate for Payer: Galaxy Health WC |
$14,582.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,293.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,440.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,894.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,227.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,122.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,431.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,009.20
|
| Rate for Payer: Multiplan Commercial |
$12,867.00
|
| Rate for Payer: Networks By Design Commercial |
$8,578.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,582.60
|
| Rate for Payer: Riverside University Health System MISP |
$6,862.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,293.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,293.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,438.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6,267.09
|
| Rate for Payer: United Healthcare HMO Rider |
$6,131.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,618.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,582.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14,582.60
|
|
|
HC CATH PENUMBRA SELECT
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000014
|
|
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 PENUMBRA SELECT
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000014
|
|
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 PERITONEAL DIALYSIS PEDS
|
Facility
|
IP
|
$99.56
|
|
| Hospital Charge Code |
901603645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$89.60 |
| Rate for Payer: Adventist Health Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Central Health Plan Commercial |
$79.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.82
|
| Rate for Payer: EPIC Health Plan Senior |
$39.82
|
| Rate for Payer: Galaxy Health WC |
$84.63
|
| Rate for Payer: Global Benefits Group Commercial |
$59.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.91
|
| Rate for Payer: Multiplan Commercial |
$74.67
|
| Rate for Payer: Networks By Design Commercial |
$64.71
|
| Rate for Payer: Prime Health Services Commercial |
$84.63
|
|
|
HC CATH PERITONEAL DIALYSIS PEDS
|
Facility
|
OP
|
$99.56
|
|
| Hospital Charge Code |
901603645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$89.60 |
| Rate for Payer: Adventist Health Commercial |
$19.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.91
|
| Rate for Payer: Blue Shield of California Commercial |
$63.12
|
| Rate for Payer: Blue Shield of California EPN |
$39.72
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Central Health Plan Commercial |
$79.65
|
| Rate for Payer: Cigna of CA HMO |
$63.72
|
| Rate for Payer: Cigna of CA PPO |
$73.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.82
|
| Rate for Payer: EPIC Health Plan Senior |
$39.82
|
| Rate for Payer: Galaxy Health WC |
$84.63
|
| Rate for Payer: Global Benefits Group Commercial |
$59.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$69.69
|
| Rate for Payer: Multiplan Commercial |
$74.67
|
| Rate for Payer: Networks By Design Commercial |
$64.71
|
| Rate for Payer: Prime Health Services Commercial |
$84.63
|
| Rate for Payer: Riverside University Health System MISP |
$39.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.78
|
| Rate for Payer: United Healthcare All Other HMO |
$49.78
|
| Rate for Payer: United Healthcare HMO Rider |
$49.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.63
|
| Rate for Payer: Vantage Medical Group Senior |
$84.63
|
|
|
HC CATH PHERESFLOW TRIPLE LUMEN
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$672.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$807.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,180.54
|
| Rate for Payer: Blue Shield of California EPN |
$741.89
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,177.60
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,030.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,251.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,324.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$534.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,030.40
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$736.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Riverside University Health System MISP |
$588.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.44
|
| Rate for Payer: United Healthcare All Other HMO |
$537.72
|
| Rate for Payer: United Healthcare HMO Rider |
$526.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$482.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
HC CATH PHERESFLOW TRIPLE LUMEN
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,180.54
|
| Rate for Payer: Blue Shield of California EPN |
$741.89
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,177.60
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,030.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,324.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$736.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.44
|
| Rate for Payer: United Healthcare All Other HMO |
$537.72
|
| Rate for Payer: United Healthcare HMO Rider |
$526.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$482.08
|
|
