|
HC CATH CV 7FR 6" TL FULL TRAY
|
Facility
|
OP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$544.95 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$276.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.27
|
| Rate for Payer: Blue Shield of California Commercial |
$468.05
|
| Rate for Payer: Blue Shield of California EPN |
$305.17
|
| Rate for Payer: Cash Price |
$333.03
|
| Rate for Payer: Central Health Plan Commercial |
$484.40
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.95
|
| Rate for Payer: InnovAge PACE Commercial |
$302.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.85
|
| Rate for Payer: Multiplan Commercial |
$454.12
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: Riverside University Health System MISP |
$242.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.67
|
| Rate for Payer: Vantage Medical Group Senior |
$514.67
|
|
|
HC CATH CV 7FR 8" TL FULL TRAY
|
Facility
|
OP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$544.95 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$276.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.27
|
| Rate for Payer: Blue Shield of California Commercial |
$468.05
|
| Rate for Payer: Blue Shield of California EPN |
$305.17
|
| Rate for Payer: Cash Price |
$333.03
|
| Rate for Payer: Central Health Plan Commercial |
$484.40
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.95
|
| Rate for Payer: InnovAge PACE Commercial |
$302.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.85
|
| Rate for Payer: Multiplan Commercial |
$454.12
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: Riverside University Health System MISP |
$242.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.67
|
| Rate for Payer: Vantage Medical Group Senior |
$514.67
|
|
|
HC CATH CV 7FR 8" TL FULL TRAY
|
Facility
|
IP
|
$605.50
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$544.95 |
| Rate for Payer: Adventist Health Commercial |
$121.10
|
| Rate for Payer: Blue Shield of California Commercial |
$468.05
|
| Rate for Payer: Blue Shield of California EPN |
$305.17
|
| Rate for Payer: Cash Price |
$333.03
|
| Rate for Payer: Central Health Plan Commercial |
$484.40
|
| Rate for Payer: Cigna of CA HMO |
$423.85
|
| Rate for Payer: Cigna of CA PPO |
$423.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.20
|
| Rate for Payer: EPIC Health Plan Senior |
$242.20
|
| Rate for Payer: Galaxy Health WC |
$514.67
|
| Rate for Payer: Global Benefits Group Commercial |
$363.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.10
|
| Rate for Payer: Multiplan Commercial |
$454.12
|
| Rate for Payer: Networks By Design Commercial |
$302.75
|
| Rate for Payer: Prime Health Services Commercial |
$514.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.24
|
| Rate for Payer: United Healthcare All Other HMO |
$221.19
|
| Rate for Payer: United Healthcare HMO Rider |
$216.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.30
|
|
|
HC CATH CV 8FR 6" DL FULL TRAY
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607562
|
|
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 |
$321.15
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| 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: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$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 CV 8FR 6" DL FULL TRAY
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607562
|
|
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 |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| 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: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$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 DIALYSIS 13FR 15CM TRIALYSIS CURVED
|
Facility
|
IP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$702.14 |
| Rate for Payer: Adventist Health Commercial |
$156.03
|
| Rate for Payer: Blue Shield of California Commercial |
$603.06
|
| Rate for Payer: Blue Shield of California EPN |
$393.20
|
| Rate for Payer: Cash Price |
$429.09
|
| Rate for Payer: Central Health Plan Commercial |
$624.13
|
| Rate for Payer: Cigna of CA HMO |
$546.11
|
| Rate for Payer: Cigna of CA PPO |
$546.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.06
|
| Rate for Payer: EPIC Health Plan Senior |
$312.06
|
| Rate for Payer: Galaxy Health WC |
$663.14
|
| Rate for Payer: Global Benefits Group Commercial |
$468.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.03
|
| Rate for Payer: Multiplan Commercial |
$585.12
|
| Rate for Payer: Networks By Design Commercial |
$390.08
|
| Rate for Payer: Prime Health Services Commercial |
$663.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.79
|
| Rate for Payer: United Healthcare All Other HMO |
$284.99
|
| Rate for Payer: United Healthcare HMO Rider |
$278.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.50
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED
|
Facility
|
OP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$702.14 |
| Rate for Payer: Adventist Health Commercial |
$156.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$356.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.97
|
| Rate for Payer: Blue Shield of California Commercial |
$603.06
|
| Rate for Payer: Blue Shield of California EPN |
$393.20
|
| Rate for Payer: Cash Price |
$429.09
|
| Rate for Payer: Central Health Plan Commercial |
$624.13
|
| Rate for Payer: Cigna of CA HMO |
$546.11
|
| Rate for Payer: Cigna of CA PPO |
$546.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.06
|
| Rate for Payer: EPIC Health Plan Senior |
$312.06
|
| Rate for Payer: Galaxy Health WC |
$663.14
|
| Rate for Payer: Global Benefits Group Commercial |
$468.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.14
|
| Rate for Payer: InnovAge PACE Commercial |
$390.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$546.11
|
| Rate for Payer: Multiplan Commercial |
$585.12
|
| Rate for Payer: Networks By Design Commercial |
$390.08
|
| Rate for Payer: Prime Health Services Commercial |
$663.14
|
| Rate for Payer: Riverside University Health System MISP |
$312.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.79
|
| Rate for Payer: United Healthcare All Other HMO |
$284.99
|
| Rate for Payer: United Healthcare HMO Rider |
$278.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.14
|
| Rate for Payer: Vantage Medical Group Senior |
$663.14
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED LEG
|
Facility
|
IP
|
$1,030.12
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.02 |
| Max. Negotiated Rate |
$927.11 |
| Rate for Payer: Adventist Health Commercial |
$206.02
|
| Rate for Payer: Blue Shield of California Commercial |
$796.28
|
| Rate for Payer: Blue Shield of California EPN |
$519.18
|
| Rate for Payer: Cash Price |
$566.57
|
| Rate for Payer: Central Health Plan Commercial |
$824.10
|
| Rate for Payer: Cigna of CA HMO |
$721.08
|
| Rate for Payer: Cigna of CA PPO |
$721.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.05
|
| Rate for Payer: EPIC Health Plan Senior |
$412.05
|
| Rate for Payer: Galaxy Health WC |
$875.60
|
| Rate for Payer: Global Benefits Group Commercial |
$618.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$637.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.02
|
| Rate for Payer: Multiplan Commercial |
$772.59
|
| Rate for Payer: Networks By Design Commercial |
$515.06
|
| Rate for Payer: Prime Health Services Commercial |
$875.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.60
|
| Rate for Payer: United Healthcare All Other HMO |
$376.30
|
| Rate for Payer: United Healthcare HMO Rider |
$368.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.36
|
|
|
HC CATH DIALYSIS 13FR 15CM TRIALYSIS CURVED LEG
|
Facility
|
OP
|
$1,030.12
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.02 |
| Max. Negotiated Rate |
$927.11 |
| Rate for Payer: Adventist Health Commercial |
$206.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$875.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$772.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$470.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$570.38
|
| Rate for Payer: Blue Shield of California Commercial |
$796.28
|
| Rate for Payer: Blue Shield of California EPN |
$519.18
|
| Rate for Payer: Cash Price |
$566.57
|
| Rate for Payer: Central Health Plan Commercial |
$824.10
|
| Rate for Payer: Cigna of CA HMO |
$721.08
|
| Rate for Payer: Cigna of CA PPO |
$721.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$875.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$875.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$875.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.05
|
| Rate for Payer: EPIC Health Plan Senior |
$412.05
|
| Rate for Payer: Galaxy Health WC |
$875.60
|
| Rate for Payer: Global Benefits Group Commercial |
$618.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.11
|
| Rate for Payer: InnovAge PACE Commercial |
$515.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$637.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$721.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$721.08
|
| Rate for Payer: Multiplan Commercial |
$772.59
|
| Rate for Payer: Networks By Design Commercial |
$515.06
|
| Rate for Payer: Prime Health Services Commercial |
$875.60
|
| Rate for Payer: Riverside University Health System MISP |
$412.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$618.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.60
|
| Rate for Payer: United Healthcare All Other HMO |
$376.30
|
| Rate for Payer: United Healthcare HMO Rider |
$368.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$875.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$875.60
|
| Rate for Payer: Vantage Medical Group Senior |
$875.60
|
|
|
HC CATH DIALYSIS 13FR 20CM KIT
|
Facility
|
IP
|
$755.87
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.17 |
| Max. Negotiated Rate |
$680.28 |
| Rate for Payer: Adventist Health Commercial |
$151.17
|
| Rate for Payer: Blue Shield of California Commercial |
$584.29
|
| Rate for Payer: Blue Shield of California EPN |
$380.96
|
| Rate for Payer: Cash Price |
$415.73
|
| Rate for Payer: Central Health Plan Commercial |
$604.70
|
| Rate for Payer: Cigna of CA HMO |
$529.11
|
| Rate for Payer: Cigna of CA PPO |
$529.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.35
|
| Rate for Payer: EPIC Health Plan Senior |
$302.35
|
| Rate for Payer: Galaxy Health WC |
$642.49
|
| Rate for Payer: Global Benefits Group Commercial |
$453.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$680.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.17
|
| Rate for Payer: Multiplan Commercial |
$566.90
|
| Rate for Payer: Networks By Design Commercial |
$377.94
|
| Rate for Payer: Prime Health Services Commercial |
$642.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.68
|
| Rate for Payer: United Healthcare All Other HMO |
$276.12
|
| Rate for Payer: United Healthcare HMO Rider |
$270.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.55
|
|
|
HC CATH DIALYSIS 13FR 20CM KIT
|
Facility
|
OP
|
$755.87
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.17 |
| Max. Negotiated Rate |
$680.28 |
| Rate for Payer: Adventist Health Commercial |
$151.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$642.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$415.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$566.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$345.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.53
|
| Rate for Payer: Blue Shield of California Commercial |
$584.29
|
| Rate for Payer: Blue Shield of California EPN |
$380.96
|
| Rate for Payer: Cash Price |
$415.73
|
| Rate for Payer: Central Health Plan Commercial |
$604.70
|
| Rate for Payer: Cigna of CA HMO |
$529.11
|
| Rate for Payer: Cigna of CA PPO |
$529.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$642.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$642.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$642.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.35
|
| Rate for Payer: EPIC Health Plan Senior |
$302.35
|
| Rate for Payer: Galaxy Health WC |
$642.49
|
| Rate for Payer: Global Benefits Group Commercial |
$453.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$680.28
|
| Rate for Payer: InnovAge PACE Commercial |
$377.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$529.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.11
|
| Rate for Payer: Multiplan Commercial |
$566.90
|
| Rate for Payer: Networks By Design Commercial |
$377.94
|
| Rate for Payer: Prime Health Services Commercial |
$642.49
|
| Rate for Payer: Riverside University Health System MISP |
$302.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.68
|
| Rate for Payer: United Healthcare All Other HMO |
$276.12
|
| Rate for Payer: United Healthcare HMO Rider |
$270.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$247.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$642.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$642.49
|
| Rate for Payer: Vantage Medical Group Senior |
$642.49
|
|
|
HC CATH DIALYSIS 13FR 20CM TRIALYSIS STRAIGHT LEG
|
Facility
|
OP
|
$976.95
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$879.25 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$537.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$732.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$446.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.94
|
| Rate for Payer: Blue Shield of California Commercial |
$755.18
|
| Rate for Payer: Blue Shield of California EPN |
$492.38
|
| Rate for Payer: Cash Price |
$537.32
|
| Rate for Payer: Central Health Plan Commercial |
$781.56
|
| Rate for Payer: Cigna of CA HMO |
$683.87
|
| Rate for Payer: Cigna of CA PPO |
$683.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$830.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$830.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.78
|
| Rate for Payer: EPIC Health Plan Senior |
$390.78
|
| Rate for Payer: Galaxy Health WC |
$830.41
|
| Rate for Payer: Global Benefits Group Commercial |
$586.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$879.25
|
| Rate for Payer: InnovAge PACE Commercial |
$488.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$651.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$604.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.87
|
| Rate for Payer: Multiplan Commercial |
$732.71
|
| Rate for Payer: Networks By Design Commercial |
$488.48
|
| Rate for Payer: Prime Health Services Commercial |
$830.41
|
| Rate for Payer: Riverside University Health System MISP |
$390.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.65
|
| Rate for Payer: United Healthcare All Other HMO |
$356.88
|
| Rate for Payer: United Healthcare HMO Rider |
$349.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$830.41
|
| Rate for Payer: Vantage Medical Group Senior |
$830.41
|
|
|
HC CATH DIALYSIS 13FR 20CM TRIALYSIS STRAIGHT LEG
|
Facility
|
IP
|
$976.95
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$879.25 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Blue Shield of California Commercial |
$755.18
|
| Rate for Payer: Blue Shield of California EPN |
$492.38
|
| Rate for Payer: Cash Price |
$537.32
|
| Rate for Payer: Central Health Plan Commercial |
$781.56
|
| Rate for Payer: Cigna of CA HMO |
$683.87
|
| Rate for Payer: Cigna of CA PPO |
$683.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.78
|
| Rate for Payer: EPIC Health Plan Senior |
$390.78
|
| Rate for Payer: Galaxy Health WC |
$830.41
|
| Rate for Payer: Global Benefits Group Commercial |
$586.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$879.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$651.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$604.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.39
|
| Rate for Payer: Multiplan Commercial |
$732.71
|
| Rate for Payer: Networks By Design Commercial |
$488.48
|
| Rate for Payer: Prime Health Services Commercial |
$830.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.65
|
| Rate for Payer: United Healthcare All Other HMO |
$356.88
|
| Rate for Payer: United Healthcare HMO Rider |
$349.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.95
|
|
|
HC CATH DIALYSIS 13FR 24CM KIT
|
Facility
|
IP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$702.14 |
| Rate for Payer: Adventist Health Commercial |
$156.03
|
| Rate for Payer: Blue Shield of California Commercial |
$603.06
|
| Rate for Payer: Blue Shield of California EPN |
$393.20
|
| Rate for Payer: Cash Price |
$429.09
|
| Rate for Payer: Central Health Plan Commercial |
$624.13
|
| Rate for Payer: Cigna of CA HMO |
$546.11
|
| Rate for Payer: Cigna of CA PPO |
$546.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.06
|
| Rate for Payer: EPIC Health Plan Senior |
$312.06
|
| Rate for Payer: Galaxy Health WC |
$663.14
|
| Rate for Payer: Global Benefits Group Commercial |
$468.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.03
|
| Rate for Payer: Multiplan Commercial |
$585.12
|
| Rate for Payer: Networks By Design Commercial |
$390.08
|
| Rate for Payer: Prime Health Services Commercial |
$663.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.79
|
| Rate for Payer: United Healthcare All Other HMO |
$284.99
|
| Rate for Payer: United Healthcare HMO Rider |
$278.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.50
|
|
|
HC CATH DIALYSIS 13FR 24CM KIT
|
Facility
|
OP
|
$780.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$702.14 |
| Rate for Payer: Adventist Health Commercial |
$156.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$356.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.97
|
| Rate for Payer: Blue Shield of California Commercial |
$603.06
|
| Rate for Payer: Blue Shield of California EPN |
$393.20
|
| Rate for Payer: Cash Price |
$429.09
|
| Rate for Payer: Central Health Plan Commercial |
$624.13
|
| Rate for Payer: Cigna of CA HMO |
$546.11
|
| Rate for Payer: Cigna of CA PPO |
$546.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.06
|
| Rate for Payer: EPIC Health Plan Senior |
$312.06
|
| Rate for Payer: Galaxy Health WC |
$663.14
|
| Rate for Payer: Global Benefits Group Commercial |
$468.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$702.14
|
| Rate for Payer: InnovAge PACE Commercial |
$390.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$546.11
|
| Rate for Payer: Multiplan Commercial |
$585.12
|
| Rate for Payer: Networks By Design Commercial |
$390.08
|
| Rate for Payer: Prime Health Services Commercial |
$663.14
|
| Rate for Payer: Riverside University Health System MISP |
$312.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.79
|
| Rate for Payer: United Healthcare All Other HMO |
$284.99
|
| Rate for Payer: United Healthcare HMO Rider |
$278.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.14
|
| Rate for Payer: Vantage Medical Group Senior |
$663.14
|
|
|
HC CATH DIALYSIS 13FR 24CM TRIALYSIS STRAIGHT
|
Facility
|
IP
|
$976.95
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$879.25 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Blue Shield of California Commercial |
$755.18
|
| Rate for Payer: Blue Shield of California EPN |
$492.38
|
| Rate for Payer: Cash Price |
$537.32
|
| Rate for Payer: Central Health Plan Commercial |
$781.56
|
| Rate for Payer: Cigna of CA HMO |
$683.87
|
| Rate for Payer: Cigna of CA PPO |
$683.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.78
|
| Rate for Payer: EPIC Health Plan Senior |
$390.78
|
| Rate for Payer: Galaxy Health WC |
$830.41
|
| Rate for Payer: Global Benefits Group Commercial |
$586.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$879.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$651.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$604.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.39
|
| Rate for Payer: Multiplan Commercial |
$732.71
|
| Rate for Payer: Networks By Design Commercial |
$488.48
|
| Rate for Payer: Prime Health Services Commercial |
$830.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.65
|
| Rate for Payer: United Healthcare All Other HMO |
$356.88
|
| Rate for Payer: United Healthcare HMO Rider |
$349.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.95
|
|
|
HC CATH DIALYSIS 13FR 24CM TRIALYSIS STRAIGHT
|
Facility
|
OP
|
$976.95
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$879.25 |
| Rate for Payer: Adventist Health Commercial |
$195.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$537.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$732.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$446.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.94
|
| Rate for Payer: Blue Shield of California Commercial |
$755.18
|
| Rate for Payer: Blue Shield of California EPN |
$492.38
|
| Rate for Payer: Cash Price |
$537.32
|
| Rate for Payer: Central Health Plan Commercial |
$781.56
|
| Rate for Payer: Cigna of CA HMO |
$683.87
|
| Rate for Payer: Cigna of CA PPO |
$683.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$830.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$830.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.78
|
| Rate for Payer: EPIC Health Plan Senior |
$390.78
|
| Rate for Payer: Galaxy Health WC |
$830.41
|
| Rate for Payer: Global Benefits Group Commercial |
$586.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$879.25
|
| Rate for Payer: InnovAge PACE Commercial |
$488.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$651.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$604.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.87
|
| Rate for Payer: Multiplan Commercial |
$732.71
|
| Rate for Payer: Networks By Design Commercial |
$488.48
|
| Rate for Payer: Prime Health Services Commercial |
$830.41
|
| Rate for Payer: Riverside University Health System MISP |
$390.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.65
|
| Rate for Payer: United Healthcare All Other HMO |
$356.88
|
| Rate for Payer: United Healthcare HMO Rider |
$349.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$830.41
|
| Rate for Payer: Vantage Medical Group Senior |
$830.41
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
IP
|
$27,832.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,566.40 |
| Max. Negotiated Rate |
$25,048.80 |
| Rate for Payer: Adventist Health Commercial |
$5,566.40
|
| Rate for Payer: Cash Price |
$15,307.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,132.80
|
| Rate for Payer: Galaxy Health WC |
$23,657.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,699.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,048.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,563.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,603.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,228.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,566.40
|
| Rate for Payer: Multiplan Commercial |
$20,874.00
|
| Rate for Payer: Networks By Design Commercial |
$18,090.80
|
| Rate for Payer: Prime Health Services Commercial |
$23,657.20
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
OP
|
$27,832.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,566.40 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,566.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$15,307.60
|
| Rate for Payer: Cash Price |
$15,307.60
|
| Rate for Payer: Cash Price |
$15,307.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,265.60
|
| Rate for Payer: Cigna of CA HMO |
$17,812.48
|
| Rate for Payer: Cigna of CA PPO |
$20,595.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$23,657.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,699.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,048.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,900.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,563.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,832.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,566.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$20,874.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$18,090.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$23,657.20
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,699.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
OP
|
$12,079.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,912.74 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,415.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$6,643.45
|
| Rate for Payer: Cash Price |
$6,643.45
|
| Rate for Payer: Cash Price |
$6,643.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,663.20
|
| Rate for Payer: Cigna of CA HMO |
$7,730.56
|
| Rate for Payer: Cigna of CA PPO |
$8,938.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$10,267.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,247.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,871.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,912.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,056.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,112.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,415.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$9,059.25
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$7,851.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$10,267.15
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,247.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
OP
|
$14,211.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
906820281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,912.74 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,842.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,368.80
|
| Rate for Payer: Cigna of CA HMO |
$9,095.04
|
| Rate for Payer: Cigna of CA PPO |
$10,516.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$12,079.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,526.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,789.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,912.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,478.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,112.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,842.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$10,658.25
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$9,237.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$12,079.35
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,526.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
IP
|
$12,079.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,415.80 |
| Max. Negotiated Rate |
$10,871.10 |
| Rate for Payer: Adventist Health Commercial |
$2,415.80
|
| Rate for Payer: Cash Price |
$6,643.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,663.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,831.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,831.60
|
| Rate for Payer: Galaxy Health WC |
$10,267.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,247.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,871.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,056.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,602.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,476.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,415.80
|
| Rate for Payer: Multiplan Commercial |
$9,059.25
|
| Rate for Payer: Networks By Design Commercial |
$7,851.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,267.15
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
IP
|
$14,211.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
906820281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,842.20 |
| Max. Negotiated Rate |
$12,789.90 |
| Rate for Payer: Adventist Health Commercial |
$2,842.20
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,368.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,684.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,684.40
|
| Rate for Payer: Galaxy Health WC |
$12,079.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,526.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,789.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,478.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,414.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,796.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,842.20
|
| Rate for Payer: Multiplan Commercial |
$10,658.25
|
| Rate for Payer: Networks By Design Commercial |
$9,237.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,079.35
|
|
|
HC CATH DIALYSIS TRAY 2LUMEN 13FR
|
Facility
|
OP
|
$2,326.66
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.33 |
| Max. Negotiated Rate |
$2,093.99 |
| Rate for Payer: Adventist Health Commercial |
$465.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,977.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,279.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,744.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,062.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,288.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,798.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,172.64
|
| Rate for Payer: Cash Price |
$1,279.66
|
| Rate for Payer: Central Health Plan Commercial |
$1,861.33
|
| Rate for Payer: Cigna of CA HMO |
$1,628.66
|
| Rate for Payer: Cigna of CA PPO |
$1,628.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,977.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,977.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,977.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.66
|
| Rate for Payer: EPIC Health Plan Senior |
$930.66
|
| Rate for Payer: Galaxy Health WC |
$1,977.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,093.99
|
| Rate for Payer: InnovAge PACE Commercial |
$1,163.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,551.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,440.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,628.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,628.66
|
| Rate for Payer: Multiplan Commercial |
$1,744.99
|
| Rate for Payer: Networks By Design Commercial |
$1,163.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,977.66
|
| Rate for Payer: Riverside University Health System MISP |
$930.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,396.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,396.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$873.20
|
| Rate for Payer: United Healthcare All Other HMO |
$849.93
|
| Rate for Payer: United Healthcare HMO Rider |
$831.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,977.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,977.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,977.66
|
|
|
HC CATH DIALYSIS TRAY 2LUMEN 13FR
|
Facility
|
IP
|
$2,326.66
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.33 |
| Max. Negotiated Rate |
$2,093.99 |
| Rate for Payer: Adventist Health Commercial |
$465.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,798.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,172.64
|
| Rate for Payer: Cash Price |
$1,279.66
|
| Rate for Payer: Central Health Plan Commercial |
$1,861.33
|
| Rate for Payer: Cigna of CA HMO |
$1,628.66
|
| Rate for Payer: Cigna of CA PPO |
$1,628.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.66
|
| Rate for Payer: EPIC Health Plan Senior |
$930.66
|
| Rate for Payer: Galaxy Health WC |
$1,977.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,093.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,551.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,440.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.33
|
| Rate for Payer: Multiplan Commercial |
$1,744.99
|
| Rate for Payer: Networks By Design Commercial |
$1,163.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,977.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$873.20
|
| Rate for Payer: United Healthcare All Other HMO |
$849.93
|
| Rate for Payer: United Healthcare HMO Rider |
$831.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.98
|
|
