|
HC CATH PEDS 10FR 3ML W 5ML SW
|
Facility
|
IP
|
$45.43
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
901607517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$40.89 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Central Health Plan Commercial |
$36.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.17
|
| Rate for Payer: EPIC Health Plan Senior |
$18.17
|
| Rate for Payer: Galaxy Health WC |
$38.62
|
| Rate for Payer: Global Benefits Group Commercial |
$27.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$34.07
|
| Rate for Payer: Networks By Design Commercial |
$29.53
|
| Rate for Payer: Prime Health Services Commercial |
$38.62
|
|
|
HC CATH PEDS 10FR 3ML W 5ML SW
|
Facility
|
OP
|
$45.43
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
901607517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$40.89 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.68
|
| Rate for Payer: Blue Shield of California Commercial |
$27.76
|
| Rate for Payer: Blue Shield of California EPN |
$18.13
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Central Health Plan Commercial |
$36.34
|
| Rate for Payer: Cigna of CA HMO |
$29.08
|
| Rate for Payer: Cigna of CA PPO |
$33.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.17
|
| Rate for Payer: EPIC Health Plan Senior |
$18.17
|
| Rate for Payer: Galaxy Health WC |
$38.62
|
| Rate for Payer: Global Benefits Group Commercial |
$27.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.89
|
| Rate for Payer: InnovAge PACE Commercial |
$22.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.80
|
| Rate for Payer: Multiplan Commercial |
$34.07
|
| Rate for Payer: Networks By Design Commercial |
$29.53
|
| Rate for Payer: Prime Health Services Commercial |
$38.62
|
| Rate for Payer: Riverside University Health System MISP |
$18.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.71
|
| Rate for Payer: United Healthcare All Other HMO |
$22.71
|
| Rate for Payer: United Healthcare HMO Rider |
$22.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.62
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
|
|
HC CATH PEDS 8FR 3ML W 5ML SW
|
Facility
|
OP
|
$49.12
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
901607396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$44.21 |
| Rate for Payer: Adventist Health Commercial |
$9.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.85
|
| Rate for Payer: Blue Shield of California Commercial |
$30.01
|
| Rate for Payer: Blue Shield of California EPN |
$19.60
|
| Rate for Payer: Cash Price |
$27.02
|
| Rate for Payer: Central Health Plan Commercial |
$39.30
|
| Rate for Payer: Cigna of CA HMO |
$31.44
|
| Rate for Payer: Cigna of CA PPO |
$36.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.65
|
| Rate for Payer: EPIC Health Plan Senior |
$19.65
|
| Rate for Payer: Galaxy Health WC |
$41.75
|
| Rate for Payer: Global Benefits Group Commercial |
$29.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.21
|
| Rate for Payer: InnovAge PACE Commercial |
$24.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.38
|
| Rate for Payer: Multiplan Commercial |
$36.84
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$41.75
|
| Rate for Payer: Riverside University Health System MISP |
$19.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.56
|
| Rate for Payer: United Healthcare All Other HMO |
$24.56
|
| Rate for Payer: United Healthcare HMO Rider |
$24.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.75
|
| Rate for Payer: Vantage Medical Group Senior |
$41.75
|
|
|
HC CATH PEDS 8FR 3ML W 5ML SW
|
Facility
|
IP
|
$49.12
|
|
|
Service Code
|
CPT A4344
|
| Hospital Charge Code |
901607396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$44.21 |
| Rate for Payer: Adventist Health Commercial |
$9.82
|
| Rate for Payer: Cash Price |
$27.02
|
| Rate for Payer: Central Health Plan Commercial |
$39.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.65
|
| Rate for Payer: EPIC Health Plan Senior |
$19.65
|
| Rate for Payer: Galaxy Health WC |
$41.75
|
| Rate for Payer: Global Benefits Group Commercial |
$29.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.82
|
| Rate for Payer: Multiplan Commercial |
$36.84
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$41.75
|
|
|
HC CATH PEDS FOLEY TRAY 10FR 5ML
|
Facility
|
OP
|
$226.45
|
|
| Hospital Charge Code |
901698909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$203.81 |
| Rate for Payer: Adventist Health Commercial |
$45.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.99
|
| Rate for Payer: Blue Shield of California Commercial |
$138.36
|
| Rate for Payer: Blue Shield of California EPN |
$90.35
|
| Rate for Payer: Cash Price |
$124.55
|
| Rate for Payer: Central Health Plan Commercial |
$181.16
|
| Rate for Payer: Cigna of CA HMO |
$144.93
|
| Rate for Payer: Cigna of CA PPO |
$167.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.58
|
| Rate for Payer: EPIC Health Plan Senior |
$90.58
|
| Rate for Payer: Galaxy Health WC |
$192.48
|
| Rate for Payer: Global Benefits Group Commercial |
$135.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.81
|
| Rate for Payer: InnovAge PACE Commercial |
$113.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.51
|
| Rate for Payer: Multiplan Commercial |
$169.84
|
| Rate for Payer: Networks By Design Commercial |
$147.19
|
| Rate for Payer: Prime Health Services Commercial |
$192.48
|
| Rate for Payer: Riverside University Health System MISP |
$90.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.22
|
| Rate for Payer: United Healthcare All Other HMO |
$113.22
|
| Rate for Payer: United Healthcare HMO Rider |
$113.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.48
|
| Rate for Payer: Vantage Medical Group Senior |
$192.48
|
|
|
HC CATH PEDS FOLEY TRAY 10FR 5ML
|
Facility
|
IP
|
$226.45
|
|
| Hospital Charge Code |
901698909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$203.81 |
| Rate for Payer: Adventist Health Commercial |
$45.29
|
| Rate for Payer: Cash Price |
$124.55
|
| Rate for Payer: Central Health Plan Commercial |
$181.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.58
|
| Rate for Payer: EPIC Health Plan Senior |
$90.58
|
| Rate for Payer: Galaxy Health WC |
$192.48
|
| Rate for Payer: Global Benefits Group Commercial |
$135.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.29
|
| Rate for Payer: Multiplan Commercial |
$169.84
|
| Rate for Payer: Networks By Design Commercial |
$147.19
|
| Rate for Payer: Prime Health Services Commercial |
$192.48
|
|
|
HC CATH PEDS FOLEY TRAY 8FR 3ML
|
Facility
|
OP
|
$202.86
|
|
| Hospital Charge Code |
901698910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$182.57 |
| Rate for Payer: Adventist Health Commercial |
$40.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.14
|
| Rate for Payer: Blue Shield of California Commercial |
$123.95
|
| Rate for Payer: Blue Shield of California EPN |
$80.94
|
| Rate for Payer: Cash Price |
$111.57
|
| Rate for Payer: Central Health Plan Commercial |
$162.29
|
| Rate for Payer: Cigna of CA HMO |
$129.83
|
| Rate for Payer: Cigna of CA PPO |
$150.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.14
|
| Rate for Payer: EPIC Health Plan Senior |
$81.14
|
| Rate for Payer: Galaxy Health WC |
$172.43
|
| Rate for Payer: Global Benefits Group Commercial |
$121.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.57
|
| Rate for Payer: InnovAge PACE Commercial |
$101.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$152.15
|
| Rate for Payer: Networks By Design Commercial |
$131.86
|
| Rate for Payer: Prime Health Services Commercial |
$172.43
|
| Rate for Payer: Riverside University Health System MISP |
$81.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.43
|
| Rate for Payer: United Healthcare All Other HMO |
$101.43
|
| Rate for Payer: United Healthcare HMO Rider |
$101.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.43
|
| Rate for Payer: Vantage Medical Group Senior |
$172.43
|
|
|
HC CATH PEDS FOLEY TRAY 8FR 3ML
|
Facility
|
IP
|
$202.86
|
|
| Hospital Charge Code |
901698910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$182.57 |
| Rate for Payer: Adventist Health Commercial |
$40.57
|
| Rate for Payer: Cash Price |
$111.57
|
| Rate for Payer: Central Health Plan Commercial |
$162.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.14
|
| Rate for Payer: EPIC Health Plan Senior |
$81.14
|
| Rate for Payer: Galaxy Health WC |
$172.43
|
| Rate for Payer: Global Benefits Group Commercial |
$121.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.57
|
| Rate for Payer: Multiplan Commercial |
$152.15
|
| Rate for Payer: Networks By Design Commercial |
$131.86
|
| Rate for Payer: Prime Health Services Commercial |
$172.43
|
|
|
HC CATH PENUMBRA 3D STNT RTRVR
|
Facility
|
OP
|
$17,156.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909011757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.20 |
| Max. Negotiated Rate |
$15,440.40 |
| Rate for Payer: Adventist Health Commercial |
$3,431.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,435.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,867.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,833.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,499.28
|
| Rate for Payer: Blue Shield of California Commercial |
$13,261.59
|
| Rate for Payer: Blue Shield of California EPN |
$8,646.62
|
| Rate for Payer: Cash Price |
$9,435.80
|
| Rate for Payer: Central Health Plan Commercial |
$13,724.80
|
| Rate for Payer: Cigna of CA HMO |
$12,009.20
|
| Rate for Payer: Cigna of CA PPO |
$12,009.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,582.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,582.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,862.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,862.40
|
| Rate for Payer: Galaxy Health WC |
$14,582.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,293.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,440.40
|
| Rate for Payer: InnovAge PACE Commercial |
$8,578.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,443.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,536.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,619.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,431.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,009.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,009.20
|
| Rate for Payer: Multiplan Commercial |
$12,867.00
|
| Rate for Payer: Networks By Design Commercial |
$8,578.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,582.60
|
| Rate for Payer: Riverside University Health System MISP |
$6,862.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,293.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,293.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,438.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6,267.09
|
| Rate for Payer: United Healthcare HMO Rider |
$6,131.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,618.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,582.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14,582.60
|
|
|
HC CATH PENUMBRA 3D STNT RTRVR
|
Facility
|
IP
|
$17,156.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909011757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.20 |
| Max. Negotiated Rate |
$15,440.40 |
| Rate for Payer: Adventist Health Commercial |
$3,431.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13,261.59
|
| Rate for Payer: Blue Shield of California EPN |
$8,646.62
|
| Rate for Payer: Cash Price |
$9,435.80
|
| Rate for Payer: Central Health Plan Commercial |
$13,724.80
|
| Rate for Payer: Cigna of CA HMO |
$12,009.20
|
| Rate for Payer: Cigna of CA PPO |
$12,009.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,862.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,862.40
|
| Rate for Payer: Galaxy Health WC |
$14,582.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,293.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,440.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,443.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,536.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,619.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,431.20
|
| Rate for Payer: Multiplan Commercial |
$12,867.00
|
| Rate for Payer: Networks By Design Commercial |
$8,578.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,582.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,438.65
|
| Rate for Payer: United Healthcare All Other HMO |
$6,267.09
|
| Rate for Payer: United Healthcare HMO Rider |
$6,131.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,618.59
|
|
|
HC CATH PENUMBRA SELECT
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC CATH PENUMBRA SELECT
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.15
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CATH PERITONEAL DIALYSIS PEDS
|
Facility
|
OP
|
$99.56
|
|
| Hospital Charge Code |
901603645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$89.60 |
| Rate for Payer: Adventist Health Commercial |
$19.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.47
|
| Rate for Payer: Blue Shield of California Commercial |
$60.83
|
| Rate for Payer: Blue Shield of California EPN |
$39.72
|
| Rate for Payer: Cash Price |
$54.76
|
| Rate for Payer: Central Health Plan Commercial |
$79.65
|
| Rate for Payer: Cigna of CA HMO |
$63.72
|
| Rate for Payer: Cigna of CA PPO |
$73.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.82
|
| Rate for Payer: EPIC Health Plan Senior |
$39.82
|
| Rate for Payer: Galaxy Health WC |
$84.63
|
| Rate for Payer: Global Benefits Group Commercial |
$59.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.60
|
| Rate for Payer: InnovAge PACE Commercial |
$49.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.69
|
| Rate for Payer: Multiplan Commercial |
$74.67
|
| Rate for Payer: Networks By Design Commercial |
$64.71
|
| Rate for Payer: Prime Health Services Commercial |
$84.63
|
| Rate for Payer: Riverside University Health System MISP |
$39.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.78
|
| Rate for Payer: United Healthcare All Other HMO |
$49.78
|
| Rate for Payer: United Healthcare HMO Rider |
$49.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.63
|
| Rate for Payer: Vantage Medical Group Senior |
$84.63
|
|
|
HC CATH PERITONEAL DIALYSIS PEDS
|
Facility
|
IP
|
$99.56
|
|
| Hospital Charge Code |
901603645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$89.60 |
| Rate for Payer: Adventist Health Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$54.76
|
| Rate for Payer: Central Health Plan Commercial |
$79.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.82
|
| Rate for Payer: EPIC Health Plan Senior |
$39.82
|
| Rate for Payer: Galaxy Health WC |
$84.63
|
| Rate for Payer: Global Benefits Group Commercial |
$59.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.91
|
| Rate for Payer: Multiplan Commercial |
$74.67
|
| Rate for Payer: Networks By Design Commercial |
$64.71
|
| Rate for Payer: Prime Health Services Commercial |
$84.63
|
|
|
HC CATH PHERESFLOW TRIPLE LUMEN
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$672.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$815.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,137.86
|
| Rate for Payer: Blue Shield of California EPN |
$741.89
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,177.60
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,030.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,324.80
|
| Rate for Payer: InnovAge PACE Commercial |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,030.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,030.40
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$736.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Riverside University Health System MISP |
$588.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.44
|
| Rate for Payer: United Healthcare All Other HMO |
$537.72
|
| Rate for Payer: United Healthcare HMO Rider |
$526.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$482.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
HC CATH PHERESFLOW TRIPLE LUMEN
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,137.86
|
| Rate for Payer: Blue Shield of California EPN |
$741.89
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,177.60
|
| Rate for Payer: Cigna of CA HMO |
$1,030.40
|
| Rate for Payer: Cigna of CA PPO |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,324.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$736.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.44
|
| Rate for Payer: United Healthcare All Other HMO |
$537.72
|
| Rate for Payer: United Healthcare HMO Rider |
$526.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$482.08
|
|
|
HC CATH PICC 4FR SL 55CM W/STYLET
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$425.92
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$275.50
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
|
|
HC CATH PICC 4FR SL 55CM W/STYLET
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$251.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.09
|
| Rate for Payer: Blue Shield of California Commercial |
$425.92
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: InnovAge PACE Commercial |
$275.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$275.50
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Riverside University Health System MISP |
$220.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC CATH PICC 5.5FR DL 55CM STYLET
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.15
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CATH PICC 5.5FR DL 55CM STYLET
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC CATH PICC 5FR DL 55CM W/STYLET
|
Facility
|
IP
|
$2,134.40
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.88 |
| Max. Negotiated Rate |
$1,920.96 |
| Rate for Payer: Adventist Health Commercial |
$426.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,075.74
|
| Rate for Payer: Cash Price |
$1,173.92
|
| Rate for Payer: Central Health Plan Commercial |
$1,707.52
|
| Rate for Payer: Cigna of CA HMO |
$1,494.08
|
| Rate for Payer: Cigna of CA PPO |
$1,494.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$853.76
|
| Rate for Payer: EPIC Health Plan Senior |
$853.76
|
| Rate for Payer: Galaxy Health WC |
$1,814.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1,280.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,920.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,423.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,321.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.88
|
| Rate for Payer: Multiplan Commercial |
$1,600.80
|
| Rate for Payer: Networks By Design Commercial |
$1,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,814.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$801.04
|
| Rate for Payer: United Healthcare All Other HMO |
$779.70
|
| Rate for Payer: United Healthcare HMO Rider |
$762.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$699.02
|
|
|
HC CATH PICC 5FR DL 55CM W/STYLET
|
Facility
|
OP
|
$2,134.40
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.88 |
| Max. Negotiated Rate |
$1,920.96 |
| Rate for Payer: Adventist Health Commercial |
$426.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,814.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,173.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,600.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$974.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,181.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,075.74
|
| Rate for Payer: Cash Price |
$1,173.92
|
| Rate for Payer: Central Health Plan Commercial |
$1,707.52
|
| Rate for Payer: Cigna of CA HMO |
$1,494.08
|
| Rate for Payer: Cigna of CA PPO |
$1,494.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,814.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,814.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,814.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$853.76
|
| Rate for Payer: EPIC Health Plan Senior |
$853.76
|
| Rate for Payer: Galaxy Health WC |
$1,814.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1,280.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,920.96
|
| Rate for Payer: InnovAge PACE Commercial |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,423.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,321.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,494.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,494.08
|
| Rate for Payer: Multiplan Commercial |
$1,600.80
|
| Rate for Payer: Networks By Design Commercial |
$1,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,814.24
|
| Rate for Payer: Riverside University Health System MISP |
$853.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,280.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,280.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$801.04
|
| Rate for Payer: United Healthcare All Other HMO |
$779.70
|
| Rate for Payer: United Healthcare HMO Rider |
$762.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$699.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,814.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,814.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,814.24
|
|
|
HC CATH PICC 6FR TL 55CM W/STYLET
|
Facility
|
OP
|
$1,666.21
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.24 |
| Max. Negotiated Rate |
$1,499.59 |
| Rate for Payer: Adventist Health Commercial |
$333.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,416.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$916.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,249.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$760.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$922.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,287.98
|
| Rate for Payer: Blue Shield of California EPN |
$839.77
|
| Rate for Payer: Cash Price |
$916.42
|
| Rate for Payer: Central Health Plan Commercial |
$1,332.97
|
| Rate for Payer: Cigna of CA HMO |
$1,166.35
|
| Rate for Payer: Cigna of CA PPO |
$1,166.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,416.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,416.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,416.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$666.48
|
| Rate for Payer: EPIC Health Plan Senior |
$666.48
|
| Rate for Payer: Galaxy Health WC |
$1,416.28
|
| Rate for Payer: Global Benefits Group Commercial |
$999.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,499.59
|
| Rate for Payer: InnovAge PACE Commercial |
$833.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,111.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,031.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,166.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,166.35
|
| Rate for Payer: Multiplan Commercial |
$1,249.66
|
| Rate for Payer: Networks By Design Commercial |
$833.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,416.28
|
| Rate for Payer: Riverside University Health System MISP |
$666.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$999.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$999.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$625.33
|
| Rate for Payer: United Healthcare All Other HMO |
$608.67
|
| Rate for Payer: United Healthcare HMO Rider |
$595.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$545.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,416.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,416.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,416.28
|
|
|
HC CATH PICC 6FR TL 55CM W/STYLET
|
Facility
|
IP
|
$1,666.21
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.24 |
| Max. Negotiated Rate |
$1,499.59 |
| Rate for Payer: Adventist Health Commercial |
$333.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,287.98
|
| Rate for Payer: Blue Shield of California EPN |
$839.77
|
| Rate for Payer: Cash Price |
$916.42
|
| Rate for Payer: Central Health Plan Commercial |
$1,332.97
|
| Rate for Payer: Cigna of CA HMO |
$1,166.35
|
| Rate for Payer: Cigna of CA PPO |
$1,166.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$666.48
|
| Rate for Payer: EPIC Health Plan Senior |
$666.48
|
| Rate for Payer: Galaxy Health WC |
$1,416.28
|
| Rate for Payer: Global Benefits Group Commercial |
$999.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,499.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,111.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,031.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.24
|
| Rate for Payer: Multiplan Commercial |
$1,249.66
|
| Rate for Payer: Networks By Design Commercial |
$833.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,416.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$625.33
|
| Rate for Payer: United Healthcare All Other HMO |
$608.67
|
| Rate for Payer: United Healthcare HMO Rider |
$595.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$545.68
|
|
|
HC CATH PICC 6FR TL 55CM W/STYLET
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
