|
HC CATH MALE EXT .30MM SPORT
|
Facility
|
IP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC CATH MALE EXT .30MM STANDARD
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
|
|
HC CATH MALE EXT .30MM STANDARD
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: Cigna of CA HMO |
$5.30
|
| Rate for Payer: Cigna of CA PPO |
$6.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: InnovAge PACE Commercial |
$4.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
| Rate for Payer: Riverside University Health System MISP |
$3.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.04
|
|
|
HC CATH MALE EXT .35MM SPORT
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.35
|
| Rate for Payer: Cigna of CA PPO |
$6.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: InnovAge PACE Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Riverside University Health System MISP |
$3.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
HC CATH MALE EXT .35MM SPORT
|
Facility
|
IP
|
$8.36
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC CATH MALE EXT .35MM STANDARD
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
|
|
HC CATH MALE EXT .35MM STANDARD
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901607608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: Cigna of CA HMO |
$5.30
|
| Rate for Payer: Cigna of CA PPO |
$6.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: InnovAge PACE Commercial |
$4.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
| Rate for Payer: Riverside University Health System MISP |
$3.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.04
|
|
|
HC CATH MALE EXTRNL SM 23MM CLR
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901698728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4.66
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Central Health Plan Commercial |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$4.88
|
| Rate for Payer: Cigna of CA PPO |
$5.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$6.49
|
| Rate for Payer: Global Benefits Group Commercial |
$4.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.34
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Networks By Design Commercial |
$4.96
|
| Rate for Payer: Prime Health Services Commercial |
$6.49
|
| Rate for Payer: Riverside University Health System MISP |
$3.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3.81
|
| Rate for Payer: United Healthcare HMO Rider |
$3.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: Vantage Medical Group Senior |
$6.49
|
|
|
HC CATH MALE EXTRNL SM 23MM CLR
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901698728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Central Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$6.49
|
| Rate for Payer: Global Benefits Group Commercial |
$4.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Networks By Design Commercial |
$4.96
|
| Rate for Payer: Prime Health Services Commercial |
$6.49
|
|
|
HC CATH MED ATTAIN COMMAND 6250A
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$794.70 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$536.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$750.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$485.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$662.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$427.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.59
|
| Rate for Payer: Blue Shield of California Commercial |
$539.51
|
| Rate for Payer: Blue Shield of California EPN |
$352.32
|
| Rate for Payer: Cash Price |
$485.65
|
| Rate for Payer: Central Health Plan Commercial |
$706.40
|
| Rate for Payer: Cigna of CA HMO |
$565.12
|
| Rate for Payer: Cigna of CA PPO |
$653.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$750.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$750.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$750.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$353.20
|
| Rate for Payer: Galaxy Health WC |
$750.55
|
| Rate for Payer: Global Benefits Group Commercial |
$529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.70
|
| Rate for Payer: InnovAge PACE Commercial |
$441.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$546.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.10
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
| Rate for Payer: Networks By Design Commercial |
$573.95
|
| Rate for Payer: Prime Health Services Commercial |
$750.55
|
| Rate for Payer: Riverside University Health System MISP |
$353.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$529.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.50
|
| Rate for Payer: United Healthcare All Other HMO |
$441.50
|
| Rate for Payer: United Healthcare HMO Rider |
$441.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$750.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$750.55
|
| Rate for Payer: Vantage Medical Group Senior |
$750.55
|
|
|
HC CATH MED ATTAIN COMMAND 6250A
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$794.70 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$485.65
|
| Rate for Payer: Central Health Plan Commercial |
$706.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$353.20
|
| Rate for Payer: Galaxy Health WC |
$750.55
|
| Rate for Payer: Global Benefits Group Commercial |
$529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$546.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.60
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
| Rate for Payer: Networks By Design Commercial |
$573.95
|
| Rate for Payer: Prime Health Services Commercial |
$750.55
|
|
|
HC CATH MED ATTAIN COMMAND 6250V
|
Facility
|
OP
|
$1,279.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.80 |
| Max. Negotiated Rate |
$1,151.10 |
| Rate for Payer: Adventist Health Commercial |
$255.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$776.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$703.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$959.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$619.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$751.16
|
| Rate for Payer: Blue Shield of California Commercial |
$781.47
|
| Rate for Payer: Blue Shield of California EPN |
$510.32
|
| Rate for Payer: Cash Price |
$703.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,023.20
|
| Rate for Payer: Cigna of CA HMO |
$818.56
|
| Rate for Payer: Cigna of CA PPO |
$946.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,087.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,087.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: EPIC Health Plan Senior |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,151.10
|
| Rate for Payer: InnovAge PACE Commercial |
$639.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$791.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$895.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$895.30
|
| Rate for Payer: Multiplan Commercial |
$959.25
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
| Rate for Payer: Riverside University Health System MISP |
$511.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$767.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$767.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.50
|
| Rate for Payer: United Healthcare All Other HMO |
$639.50
|
| Rate for Payer: United Healthcare HMO Rider |
$639.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$639.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,087.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,087.15
|
|
|
HC CATH MED ATTAIN COMMAND 6250V
|
Facility
|
IP
|
$1,279.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.80 |
| Max. Negotiated Rate |
$1,151.10 |
| Rate for Payer: Adventist Health Commercial |
$255.80
|
| Rate for Payer: Cash Price |
$703.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: EPIC Health Plan Senior |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,151.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$791.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.80
|
| Rate for Payer: Multiplan Commercial |
$959.25
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
|
|
HC CATH MED ATTAIN COMMAND SYSTEM
|
Facility
|
OP
|
$2,917.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,771.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,604.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,187.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,412.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,713.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,782.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,163.88
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$1,866.88
|
| Rate for Payer: Cigna of CA PPO |
$2,158.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,479.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,479.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,041.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,041.90
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,896.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,750.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,750.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,458.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,458.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,458.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,458.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,479.45
|
|
|
HC CATH MED ATTAIN COMMAND SYSTEM
|
Facility
|
IP
|
$2,917.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,896.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
|
|
HC CATH MED ATTAIN DELIVERY SYSTEM
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,350.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,405.30
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC CATH MED ATTAIN DELIVERY SYSTEM
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC CATH MED ATTAIN SELECT 6238TEL
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$360.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.54
|
| Rate for Payer: Blue Shield of California Commercial |
$455.19
|
| Rate for Payer: Blue Shield of California EPN |
$297.25
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$476.80
|
| Rate for Payer: Cigna of CA PPO |
$551.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: InnovAge PACE Commercial |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Riverside University Health System MISP |
$298.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$372.50
|
| Rate for Payer: United Healthcare All Other HMO |
$372.50
|
| Rate for Payer: United Healthcare HMO Rider |
$372.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$372.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC CATH MED ATTAIN SELECT 6238TEL
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC CATH MED ATTAIN SELECT II 6248
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Adventist Health Commercial |
$174.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$530.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$742.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$480.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$655.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$423.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$513.30
|
| Rate for Payer: Blue Shield of California Commercial |
$534.01
|
| Rate for Payer: Blue Shield of California EPN |
$348.73
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: Central Health Plan Commercial |
$699.20
|
| Rate for Payer: Cigna of CA HMO |
$559.36
|
| Rate for Payer: Cigna of CA PPO |
$646.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$742.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$742.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$349.60
|
| Rate for Payer: EPIC Health Plan Senior |
$349.60
|
| Rate for Payer: Galaxy Health WC |
$742.90
|
| Rate for Payer: Global Benefits Group Commercial |
$524.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$786.60
|
| Rate for Payer: InnovAge PACE Commercial |
$437.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$582.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$611.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$611.80
|
| Rate for Payer: Multiplan Commercial |
$655.50
|
| Rate for Payer: Networks By Design Commercial |
$568.10
|
| Rate for Payer: Prime Health Services Commercial |
$742.90
|
| Rate for Payer: Riverside University Health System MISP |
$349.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$524.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$524.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$437.00
|
| Rate for Payer: United Healthcare All Other HMO |
$437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$437.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$437.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$742.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.90
|
| Rate for Payer: Vantage Medical Group Senior |
$742.90
|
|
|
HC CATH MED ATTAIN SELECT II 6248
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Adventist Health Commercial |
$174.80
|
| Rate for Payer: Cash Price |
$480.70
|
| Rate for Payer: Central Health Plan Commercial |
$699.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$349.60
|
| Rate for Payer: EPIC Health Plan Senior |
$349.60
|
| Rate for Payer: Galaxy Health WC |
$742.90
|
| Rate for Payer: Global Benefits Group Commercial |
$524.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$786.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$582.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$655.50
|
| Rate for Payer: Networks By Design Commercial |
$568.10
|
| Rate for Payer: Prime Health Services Commercial |
$742.90
|
|
|
HC CATH MED ATTAIN SELECT II 6248V
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$1,001.70 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Central Health Plan Commercial |
$890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.20
|
| Rate for Payer: EPIC Health Plan Senior |
$445.20
|
| Rate for Payer: Galaxy Health WC |
$946.05
|
| Rate for Payer: Global Benefits Group Commercial |
$667.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$742.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$688.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.60
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
| Rate for Payer: Networks By Design Commercial |
$723.45
|
| Rate for Payer: Prime Health Services Commercial |
$946.05
|
|
|
HC CATH MED ATTAIN SELECT II 6248V
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$1,001.70 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$675.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$946.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$612.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$834.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$538.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$653.66
|
| Rate for Payer: Blue Shield of California Commercial |
$680.04
|
| Rate for Payer: Blue Shield of California EPN |
$444.09
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Central Health Plan Commercial |
$890.40
|
| Rate for Payer: Cigna of CA HMO |
$712.32
|
| Rate for Payer: Cigna of CA PPO |
$823.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$946.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$946.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$946.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.20
|
| Rate for Payer: EPIC Health Plan Senior |
$445.20
|
| Rate for Payer: Galaxy Health WC |
$946.05
|
| Rate for Payer: Global Benefits Group Commercial |
$667.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.70
|
| Rate for Payer: InnovAge PACE Commercial |
$556.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$742.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$688.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$779.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$779.10
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
| Rate for Payer: Networks By Design Commercial |
$723.45
|
| Rate for Payer: Prime Health Services Commercial |
$946.05
|
| Rate for Payer: Riverside University Health System MISP |
$445.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$667.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$667.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$556.50
|
| Rate for Payer: United Healthcare All Other HMO |
$556.50
|
| Rate for Payer: United Healthcare HMO Rider |
$556.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$556.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$946.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$946.05
|
| Rate for Payer: Vantage Medical Group Senior |
$946.05
|
|
|
HC CATH MED ATTAIN SYS 6250 VC VS
|
Facility
|
IP
|
$2,917.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,896.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
|
|
HC CATH MED ATTAIN SYS 6250 VC VS
|
Facility
|
OP
|
$2,917.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,771.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,604.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,187.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,412.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,713.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,782.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,163.88
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$1,866.88
|
| Rate for Payer: Cigna of CA PPO |
$2,158.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,479.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,479.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,041.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,041.90
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,896.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,750.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,750.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,458.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,458.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,458.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,458.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,479.45
|
|
