|
HC CATH UMBILICAL 1 LUMEN 3.5FR
|
Facility
|
OP
|
$97.36
|
|
| Hospital Charge Code |
901698574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$19.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.63
|
| Rate for Payer: Blue Shield of California Commercial |
$61.73
|
| Rate for Payer: Blue Shield of California EPN |
$38.85
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$62.31
|
| Rate for Payer: Cigna of CA PPO |
$72.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.15
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$63.28
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: Riverside University Health System MISP |
$38.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.68
|
| Rate for Payer: United Healthcare All Other HMO |
$48.68
|
| Rate for Payer: United Healthcare HMO Rider |
$48.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.76
|
| Rate for Payer: Vantage Medical Group Senior |
$82.76
|
|
|
HC CATH UMBILICAL 3.5FR SGL LUMEN
|
Facility
|
OP
|
$95.38
|
|
| Hospital Charge Code |
901698407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.48
|
| Rate for Payer: Blue Shield of California Commercial |
$60.47
|
| Rate for Payer: Blue Shield of California EPN |
$38.06
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Central Health Plan Commercial |
$76.30
|
| Rate for Payer: Cigna of CA HMO |
$61.04
|
| Rate for Payer: Cigna of CA PPO |
$70.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66.77
|
| Rate for Payer: Multiplan Commercial |
$71.53
|
| Rate for Payer: Networks By Design Commercial |
$62.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: Riverside University Health System MISP |
$38.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.69
|
| Rate for Payer: United Healthcare All Other HMO |
$47.69
|
| Rate for Payer: United Healthcare HMO Rider |
$47.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.07
|
| Rate for Payer: Vantage Medical Group Senior |
$81.07
|
|
|
HC CATH UMBILICAL 3.5FR SGL LUMEN
|
Facility
|
IP
|
$95.38
|
|
| Hospital Charge Code |
901698407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Central Health Plan Commercial |
$76.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$71.53
|
| Rate for Payer: Networks By Design Commercial |
$62.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
|
|
HC CATH UMBILICAL 5FR 1 LUMEN
|
Facility
|
OP
|
$106.40
|
|
| Hospital Charge Code |
901698631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.89
|
| Rate for Payer: Blue Shield of California Commercial |
$67.46
|
| Rate for Payer: Blue Shield of California EPN |
$42.45
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: Cigna of CA HMO |
$68.10
|
| Rate for Payer: Cigna of CA PPO |
$78.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.48
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
| Rate for Payer: Riverside University Health System MISP |
$42.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO |
$53.20
|
| Rate for Payer: United Healthcare HMO Rider |
$53.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC CATH UMBILICAL 5FR 1 LUMEN
|
Facility
|
IP
|
$106.40
|
|
| Hospital Charge Code |
901698631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
|
|
HC CATH UMBILICAL 5FR DUAL LUMEN
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
901698632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.16
|
| Rate for Payer: Blue Shield of California Commercial |
$133.14
|
| Rate for Payer: Blue Shield of California EPN |
$83.79
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC CATH UMBILICAL 5FR DUAL LUMEN
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
901698632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC CATH UMBILICAL ARTERY 3.5FR
|
Facility
|
IP
|
$117.65
|
|
| Hospital Charge Code |
901601458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$105.89 |
| Rate for Payer: Adventist Health Commercial |
$23.53
|
| Rate for Payer: Cash Price |
$52.94
|
| Rate for Payer: Central Health Plan Commercial |
$94.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.06
|
| Rate for Payer: EPIC Health Plan Senior |
$47.06
|
| Rate for Payer: Galaxy Health WC |
$100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$70.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.53
|
| Rate for Payer: Multiplan Commercial |
$88.24
|
| Rate for Payer: Networks By Design Commercial |
$76.47
|
| Rate for Payer: Prime Health Services Commercial |
$100.00
|
|
|
HC CATH UMBILICAL ARTERY 3.5FR
|
Facility
|
OP
|
$117.65
|
|
| Hospital Charge Code |
901601458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$105.89 |
| Rate for Payer: Adventist Health Commercial |
$23.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.44
|
| Rate for Payer: Blue Shield of California Commercial |
$74.59
|
| Rate for Payer: Blue Shield of California EPN |
$46.94
|
| Rate for Payer: Cash Price |
$52.94
|
| Rate for Payer: Central Health Plan Commercial |
$94.12
|
| Rate for Payer: Cigna of CA HMO |
$75.30
|
| Rate for Payer: Cigna of CA PPO |
$87.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.06
|
| Rate for Payer: EPIC Health Plan Senior |
$47.06
|
| Rate for Payer: Galaxy Health WC |
$100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$70.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$82.36
|
| Rate for Payer: Multiplan Commercial |
$88.24
|
| Rate for Payer: Networks By Design Commercial |
$76.47
|
| Rate for Payer: Prime Health Services Commercial |
$100.00
|
| Rate for Payer: Riverside University Health System MISP |
$47.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.83
|
| Rate for Payer: United Healthcare All Other HMO |
$58.83
|
| Rate for Payer: United Healthcare HMO Rider |
$58.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.00
|
| Rate for Payer: Vantage Medical Group Senior |
$100.00
|
|
|
HC CATH UMBILICAL ARTERY 5FR 15"
|
Facility
|
IP
|
$117.65
|
|
| Hospital Charge Code |
901601459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$105.89 |
| Rate for Payer: Adventist Health Commercial |
$23.53
|
| Rate for Payer: Cash Price |
$52.94
|
| Rate for Payer: Central Health Plan Commercial |
$94.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.06
|
| Rate for Payer: EPIC Health Plan Senior |
$47.06
|
| Rate for Payer: Galaxy Health WC |
$100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$70.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.53
|
| Rate for Payer: Multiplan Commercial |
$88.24
|
| Rate for Payer: Networks By Design Commercial |
$76.47
|
| Rate for Payer: Prime Health Services Commercial |
$100.00
|
|
|
HC CATH UMBILICAL ARTERY 5FR 15"
|
Facility
|
OP
|
$117.65
|
|
| Hospital Charge Code |
901601459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$105.89 |
| Rate for Payer: Adventist Health Commercial |
$23.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.44
|
| Rate for Payer: Blue Shield of California Commercial |
$74.59
|
| Rate for Payer: Blue Shield of California EPN |
$46.94
|
| Rate for Payer: Cash Price |
$52.94
|
| Rate for Payer: Central Health Plan Commercial |
$94.12
|
| Rate for Payer: Cigna of CA HMO |
$75.30
|
| Rate for Payer: Cigna of CA PPO |
$87.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.06
|
| Rate for Payer: EPIC Health Plan Senior |
$47.06
|
| Rate for Payer: Galaxy Health WC |
$100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$70.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$82.36
|
| Rate for Payer: Multiplan Commercial |
$88.24
|
| Rate for Payer: Networks By Design Commercial |
$76.47
|
| Rate for Payer: Prime Health Services Commercial |
$100.00
|
| Rate for Payer: Riverside University Health System MISP |
$47.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.83
|
| Rate for Payer: United Healthcare All Other HMO |
$58.83
|
| Rate for Payer: United Healthcare HMO Rider |
$58.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.00
|
| Rate for Payer: Vantage Medical Group Senior |
$100.00
|
|
|
HC CATH UMBILICAL HOLDER MICRO
|
Facility
|
IP
|
$51.50
|
|
| Hospital Charge Code |
901698784
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Adventist Health Commercial |
$10.30
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Central Health Plan Commercial |
$41.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20.60
|
| Rate for Payer: Galaxy Health WC |
$43.77
|
| Rate for Payer: Global Benefits Group Commercial |
$30.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.30
|
| Rate for Payer: Multiplan Commercial |
$38.62
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
|
|
HC CATH UMBILICAL HOLDER MICRO
|
Facility
|
OP
|
$51.50
|
|
| Hospital Charge Code |
901698784
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Adventist Health Commercial |
$10.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.96
|
| Rate for Payer: Blue Shield of California Commercial |
$32.65
|
| Rate for Payer: Blue Shield of California EPN |
$20.55
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Central Health Plan Commercial |
$41.20
|
| Rate for Payer: Cigna of CA HMO |
$32.96
|
| Rate for Payer: Cigna of CA PPO |
$38.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20.60
|
| Rate for Payer: Galaxy Health WC |
$43.77
|
| Rate for Payer: Global Benefits Group Commercial |
$30.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.05
|
| Rate for Payer: Multiplan Commercial |
$38.62
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
| Rate for Payer: Riverside University Health System MISP |
$20.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.75
|
| Rate for Payer: United Healthcare All Other HMO |
$25.75
|
| Rate for Payer: United Healthcare HMO Rider |
$25.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.77
|
| Rate for Payer: Vantage Medical Group Senior |
$43.77
|
|
|
HC CATH UMBILICAL POLY DUAL 3.5FR
|
Facility
|
OP
|
$234.50
|
|
| Hospital Charge Code |
901698904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$211.05 |
| Rate for Payer: Adventist Health Commercial |
$46.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.41
|
| Rate for Payer: Blue Shield of California Commercial |
$148.67
|
| Rate for Payer: Blue Shield of California EPN |
$93.57
|
| Rate for Payer: Cash Price |
$105.52
|
| Rate for Payer: Central Health Plan Commercial |
$187.60
|
| Rate for Payer: Cigna of CA HMO |
$150.08
|
| Rate for Payer: Cigna of CA PPO |
$173.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.80
|
| Rate for Payer: EPIC Health Plan Senior |
$93.80
|
| Rate for Payer: Galaxy Health WC |
$199.32
|
| Rate for Payer: Global Benefits Group Commercial |
$140.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$164.15
|
| Rate for Payer: Multiplan Commercial |
$175.88
|
| Rate for Payer: Networks By Design Commercial |
$152.43
|
| Rate for Payer: Prime Health Services Commercial |
$199.32
|
| Rate for Payer: Riverside University Health System MISP |
$93.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.25
|
| Rate for Payer: United Healthcare All Other HMO |
$117.25
|
| Rate for Payer: United Healthcare HMO Rider |
$117.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.32
|
| Rate for Payer: Vantage Medical Group Senior |
$199.32
|
|
|
HC CATH UMBILICAL POLY DUAL 3.5FR
|
Facility
|
IP
|
$234.50
|
|
| Hospital Charge Code |
901698904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$211.05 |
| Rate for Payer: Adventist Health Commercial |
$46.90
|
| Rate for Payer: Cash Price |
$105.52
|
| Rate for Payer: Central Health Plan Commercial |
$187.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.80
|
| Rate for Payer: EPIC Health Plan Senior |
$93.80
|
| Rate for Payer: Galaxy Health WC |
$199.32
|
| Rate for Payer: Global Benefits Group Commercial |
$140.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.90
|
| Rate for Payer: Multiplan Commercial |
$175.88
|
| Rate for Payer: Networks By Design Commercial |
$152.43
|
| Rate for Payer: Prime Health Services Commercial |
$199.32
|
|
|
HC CATH UMBILICAL VESL DL 3.5FR
|
Facility
|
OP
|
$422.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$380.02 |
| Rate for Payer: Adventist Health Commercial |
$84.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$358.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$316.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$192.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.56
|
| Rate for Payer: Blue Shield of California Commercial |
$338.64
|
| Rate for Payer: Blue Shield of California EPN |
$212.81
|
| Rate for Payer: Cash Price |
$190.01
|
| Rate for Payer: Central Health Plan Commercial |
$337.79
|
| Rate for Payer: Cigna of CA HMO |
$295.57
|
| Rate for Payer: Cigna of CA PPO |
$295.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$358.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$358.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$295.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.90
|
| Rate for Payer: EPIC Health Plan Senior |
$168.90
|
| Rate for Payer: Galaxy Health WC |
$358.90
|
| Rate for Payer: Global Benefits Group Commercial |
$253.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$268.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$249.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$295.57
|
| Rate for Payer: Multiplan Commercial |
$316.68
|
| Rate for Payer: Networks By Design Commercial |
$211.12
|
| Rate for Payer: Prime Health Services Commercial |
$358.90
|
| Rate for Payer: Riverside University Health System MISP |
$168.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.47
|
| Rate for Payer: United Healthcare All Other HMO |
$154.24
|
| Rate for Payer: United Healthcare HMO Rider |
$150.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$358.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.90
|
| Rate for Payer: Vantage Medical Group Senior |
$358.90
|
|
|
HC CATH UMBILICAL VESL DL 3.5FR
|
Facility
|
IP
|
$422.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$380.02 |
| Rate for Payer: Adventist Health Commercial |
$84.45
|
| Rate for Payer: Blue Shield of California Commercial |
$338.64
|
| Rate for Payer: Blue Shield of California EPN |
$212.81
|
| Rate for Payer: Cash Price |
$190.01
|
| Rate for Payer: Central Health Plan Commercial |
$337.79
|
| Rate for Payer: Cigna of CA HMO |
$295.57
|
| Rate for Payer: Cigna of CA PPO |
$295.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$295.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.90
|
| Rate for Payer: EPIC Health Plan Senior |
$168.90
|
| Rate for Payer: Galaxy Health WC |
$358.90
|
| Rate for Payer: Global Benefits Group Commercial |
$253.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$268.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$249.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.45
|
| Rate for Payer: Multiplan Commercial |
$316.68
|
| Rate for Payer: Networks By Design Commercial |
$211.12
|
| Rate for Payer: Prime Health Services Commercial |
$358.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.47
|
| Rate for Payer: United Healthcare All Other HMO |
$154.24
|
| Rate for Payer: United Healthcare HMO Rider |
$150.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.28
|
|
|
HC CATH UMBILICAL VESSEL 3.5FR
|
Facility
|
OP
|
$272.93
|
|
| Hospital Charge Code |
901698903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.59 |
| Max. Negotiated Rate |
$245.64 |
| Rate for Payer: Adventist Health Commercial |
$54.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.76
|
| Rate for Payer: Blue Shield of California Commercial |
$173.04
|
| Rate for Payer: Blue Shield of California EPN |
$108.90
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Central Health Plan Commercial |
$218.34
|
| Rate for Payer: Cigna of CA HMO |
$174.68
|
| Rate for Payer: Cigna of CA PPO |
$201.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.17
|
| Rate for Payer: EPIC Health Plan Senior |
$109.17
|
| Rate for Payer: Galaxy Health WC |
$231.99
|
| Rate for Payer: Global Benefits Group Commercial |
$163.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.05
|
| Rate for Payer: Multiplan Commercial |
$204.70
|
| Rate for Payer: Networks By Design Commercial |
$177.40
|
| Rate for Payer: Prime Health Services Commercial |
$231.99
|
| Rate for Payer: Riverside University Health System MISP |
$109.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.47
|
| Rate for Payer: United Healthcare All Other HMO |
$136.47
|
| Rate for Payer: United Healthcare HMO Rider |
$136.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.99
|
| Rate for Payer: Vantage Medical Group Senior |
$231.99
|
|
|
HC CATH UMBILICAL VESSEL 3.5FR
|
Facility
|
IP
|
$272.93
|
|
| Hospital Charge Code |
901698903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.59 |
| Max. Negotiated Rate |
$245.64 |
| Rate for Payer: Adventist Health Commercial |
$54.59
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Central Health Plan Commercial |
$218.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.17
|
| Rate for Payer: EPIC Health Plan Senior |
$109.17
|
| Rate for Payer: Galaxy Health WC |
$231.99
|
| Rate for Payer: Global Benefits Group Commercial |
$163.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.59
|
| Rate for Payer: Multiplan Commercial |
$204.70
|
| Rate for Payer: Networks By Design Commercial |
$177.40
|
| Rate for Payer: Prime Health Services Commercial |
$231.99
|
|
|
HC CATH UMBILICAL VESSEL 5.0FR
|
Facility
|
IP
|
$272.86
|
|
| Hospital Charge Code |
901603823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$245.57 |
| Rate for Payer: Adventist Health Commercial |
$54.57
|
| Rate for Payer: Cash Price |
$122.79
|
| Rate for Payer: Central Health Plan Commercial |
$218.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.14
|
| Rate for Payer: EPIC Health Plan Senior |
$109.14
|
| Rate for Payer: Galaxy Health WC |
$231.93
|
| Rate for Payer: Global Benefits Group Commercial |
$163.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.57
|
| Rate for Payer: Multiplan Commercial |
$204.65
|
| Rate for Payer: Networks By Design Commercial |
$177.36
|
| Rate for Payer: Prime Health Services Commercial |
$231.93
|
|
|
HC CATH UMBILICAL VESSEL 5.0FR
|
Facility
|
OP
|
$272.86
|
|
| Hospital Charge Code |
901603823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$245.57 |
| Rate for Payer: Adventist Health Commercial |
$54.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.72
|
| Rate for Payer: Blue Shield of California Commercial |
$172.99
|
| Rate for Payer: Blue Shield of California EPN |
$108.87
|
| Rate for Payer: Cash Price |
$122.79
|
| Rate for Payer: Central Health Plan Commercial |
$218.29
|
| Rate for Payer: Cigna of CA HMO |
$174.63
|
| Rate for Payer: Cigna of CA PPO |
$201.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.14
|
| Rate for Payer: EPIC Health Plan Senior |
$109.14
|
| Rate for Payer: Galaxy Health WC |
$231.93
|
| Rate for Payer: Global Benefits Group Commercial |
$163.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.00
|
| Rate for Payer: Multiplan Commercial |
$204.65
|
| Rate for Payer: Networks By Design Commercial |
$177.36
|
| Rate for Payer: Prime Health Services Commercial |
$231.93
|
| Rate for Payer: Riverside University Health System MISP |
$109.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.43
|
| Rate for Payer: United Healthcare All Other HMO |
$136.43
|
| Rate for Payer: United Healthcare HMO Rider |
$136.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.93
|
| Rate for Payer: Vantage Medical Group Senior |
$231.93
|
|
|
HC CATH URETHRAL 14FR PVC
|
Facility
|
OP
|
$3.69
|
|
| Hospital Charge Code |
901698527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.36
|
| Rate for Payer: Cigna of CA PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Riverside University Health System MISP |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
HC CATH URETHRAL 14FR PVC
|
Facility
|
IP
|
$3.69
|
|
| Hospital Charge Code |
901698527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
|
|
HC CATH URETHRAL PVP KIT 14FR
|
Facility
|
IP
|
$20.66
|
|
| Hospital Charge Code |
901698633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Central Health Plan Commercial |
$16.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$15.49
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
|
|
HC CATH URETHRAL PVP KIT 14FR
|
Facility
|
OP
|
$20.66
|
|
| Hospital Charge Code |
901698633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.10
|
| Rate for Payer: Blue Shield of California EPN |
$8.24
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Central Health Plan Commercial |
$16.53
|
| Rate for Payer: Cigna of CA HMO |
$13.22
|
| Rate for Payer: Cigna of CA PPO |
$15.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$15.49
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.56
|
| Rate for Payer: Vantage Medical Group Senior |
$17.56
|
|
