|
HC CATH UMBILICAL HOLDER MICRO
|
Facility
|
IP
|
$51.50
|
|
| Hospital Charge Code |
901698784
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Adventist Health Commercial |
$10.30
|
| Rate for Payer: Cash Price |
$28.33
|
| Rate for Payer: Central Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20.60
|
| Rate for Payer: Galaxy Health WC |
$43.77
|
| Rate for Payer: Global Benefits Group Commercial |
$30.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.30
|
| Rate for Payer: Multiplan Commercial |
$38.62
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
|
|
HC CATH UMBILICAL HOLDER MICRO
|
Facility
|
OP
|
$51.50
|
|
| Hospital Charge Code |
901698784
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Adventist Health Commercial |
$10.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.25
|
| Rate for Payer: Blue Shield of California Commercial |
$31.47
|
| Rate for Payer: Blue Shield of California EPN |
$20.55
|
| Rate for Payer: Cash Price |
$28.33
|
| Rate for Payer: Central Health Plan Commercial |
$41.20
|
| Rate for Payer: Cigna of CA HMO |
$32.96
|
| Rate for Payer: Cigna of CA PPO |
$38.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20.60
|
| Rate for Payer: Galaxy Health WC |
$43.77
|
| Rate for Payer: Global Benefits Group Commercial |
$30.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.35
|
| Rate for Payer: InnovAge PACE Commercial |
$25.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.05
|
| Rate for Payer: Multiplan Commercial |
$38.62
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
| Rate for Payer: Riverside University Health System MISP |
$20.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.75
|
| Rate for Payer: United Healthcare All Other HMO |
$25.75
|
| Rate for Payer: United Healthcare HMO Rider |
$25.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.77
|
| Rate for Payer: Vantage Medical Group Senior |
$43.77
|
|
|
HC CATH UMBILICAL POLY DUAL 3.5FR
|
Facility
|
IP
|
$234.50
|
|
| Hospital Charge Code |
901698904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$211.05 |
| Rate for Payer: Adventist Health Commercial |
$46.90
|
| Rate for Payer: Cash Price |
$128.98
|
| Rate for Payer: Central Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.80
|
| Rate for Payer: EPIC Health Plan Senior |
$93.80
|
| Rate for Payer: Galaxy Health WC |
$199.32
|
| Rate for Payer: Global Benefits Group Commercial |
$140.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.90
|
| Rate for Payer: Multiplan Commercial |
$175.88
|
| Rate for Payer: Networks By Design Commercial |
$152.43
|
| Rate for Payer: Prime Health Services Commercial |
$199.32
|
|
|
HC CATH UMBILICAL POLY DUAL 3.5FR
|
Facility
|
OP
|
$234.50
|
|
| Hospital Charge Code |
901698904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$211.05 |
| Rate for Payer: Adventist Health Commercial |
$46.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.72
|
| Rate for Payer: Blue Shield of California Commercial |
$143.28
|
| Rate for Payer: Blue Shield of California EPN |
$93.57
|
| Rate for Payer: Cash Price |
$128.98
|
| Rate for Payer: Central Health Plan Commercial |
$187.60
|
| Rate for Payer: Cigna of CA HMO |
$150.08
|
| Rate for Payer: Cigna of CA PPO |
$173.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.80
|
| Rate for Payer: EPIC Health Plan Senior |
$93.80
|
| Rate for Payer: Galaxy Health WC |
$199.32
|
| Rate for Payer: Global Benefits Group Commercial |
$140.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.05
|
| Rate for Payer: InnovAge PACE Commercial |
$117.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.15
|
| Rate for Payer: Multiplan Commercial |
$175.88
|
| Rate for Payer: Networks By Design Commercial |
$152.43
|
| Rate for Payer: Prime Health Services Commercial |
$199.32
|
| Rate for Payer: Riverside University Health System MISP |
$93.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.25
|
| Rate for Payer: United Healthcare All Other HMO |
$117.25
|
| Rate for Payer: United Healthcare HMO Rider |
$117.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.32
|
| Rate for Payer: Vantage Medical Group Senior |
$199.32
|
|
|
HC CATH UMBILICAL VESL DL 3.5FR
|
Facility
|
IP
|
$422.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$380.02 |
| Rate for Payer: Adventist Health Commercial |
$84.45
|
| Rate for Payer: Blue Shield of California Commercial |
$326.39
|
| Rate for Payer: Blue Shield of California EPN |
$212.81
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Central Health Plan Commercial |
$337.79
|
| Rate for Payer: Cigna of CA HMO |
$295.57
|
| Rate for Payer: Cigna of CA PPO |
$295.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.90
|
| Rate for Payer: EPIC Health Plan Senior |
$168.90
|
| Rate for Payer: Galaxy Health WC |
$358.90
|
| Rate for Payer: Global Benefits Group Commercial |
$253.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$281.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.45
|
| Rate for Payer: Multiplan Commercial |
$316.68
|
| Rate for Payer: Networks By Design Commercial |
$211.12
|
| Rate for Payer: Prime Health Services Commercial |
$358.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.47
|
| Rate for Payer: United Healthcare All Other HMO |
$154.24
|
| Rate for Payer: United Healthcare HMO Rider |
$150.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.28
|
|
|
HC CATH UMBILICAL VESL DL 3.5FR
|
Facility
|
OP
|
$422.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$380.02 |
| Rate for Payer: Adventist Health Commercial |
$84.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$358.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$316.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$192.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.79
|
| Rate for Payer: Blue Shield of California Commercial |
$326.39
|
| Rate for Payer: Blue Shield of California EPN |
$212.81
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Central Health Plan Commercial |
$337.79
|
| Rate for Payer: Cigna of CA HMO |
$295.57
|
| Rate for Payer: Cigna of CA PPO |
$295.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$358.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$358.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.90
|
| Rate for Payer: EPIC Health Plan Senior |
$168.90
|
| Rate for Payer: Galaxy Health WC |
$358.90
|
| Rate for Payer: Global Benefits Group Commercial |
$253.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.02
|
| Rate for Payer: InnovAge PACE Commercial |
$211.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$281.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$295.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$295.57
|
| Rate for Payer: Multiplan Commercial |
$316.68
|
| Rate for Payer: Networks By Design Commercial |
$211.12
|
| Rate for Payer: Prime Health Services Commercial |
$358.90
|
| Rate for Payer: Riverside University Health System MISP |
$168.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.47
|
| Rate for Payer: United Healthcare All Other HMO |
$154.24
|
| Rate for Payer: United Healthcare HMO Rider |
$150.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$358.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.90
|
| Rate for Payer: Vantage Medical Group Senior |
$358.90
|
|
|
HC CATH UMBILICAL VESSEL 3.5FR
|
Facility
|
IP
|
$272.93
|
|
| Hospital Charge Code |
901698903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.59 |
| Max. Negotiated Rate |
$245.64 |
| Rate for Payer: Adventist Health Commercial |
$54.59
|
| Rate for Payer: Cash Price |
$150.11
|
| Rate for Payer: Central Health Plan Commercial |
$218.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.17
|
| Rate for Payer: EPIC Health Plan Senior |
$109.17
|
| Rate for Payer: Galaxy Health WC |
$231.99
|
| Rate for Payer: Global Benefits Group Commercial |
$163.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.59
|
| Rate for Payer: Multiplan Commercial |
$204.70
|
| Rate for Payer: Networks By Design Commercial |
$177.40
|
| Rate for Payer: Prime Health Services Commercial |
$231.99
|
|
|
HC CATH UMBILICAL VESSEL 3.5FR
|
Facility
|
OP
|
$272.93
|
|
| Hospital Charge Code |
901698903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.59 |
| Max. Negotiated Rate |
$245.64 |
| Rate for Payer: Adventist Health Commercial |
$54.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.29
|
| Rate for Payer: Blue Shield of California Commercial |
$166.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.90
|
| Rate for Payer: Cash Price |
$150.11
|
| Rate for Payer: Central Health Plan Commercial |
$218.34
|
| Rate for Payer: Cigna of CA HMO |
$174.68
|
| Rate for Payer: Cigna of CA PPO |
$201.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.17
|
| Rate for Payer: EPIC Health Plan Senior |
$109.17
|
| Rate for Payer: Galaxy Health WC |
$231.99
|
| Rate for Payer: Global Benefits Group Commercial |
$163.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.64
|
| Rate for Payer: InnovAge PACE Commercial |
$136.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.05
|
| Rate for Payer: Multiplan Commercial |
$204.70
|
| Rate for Payer: Networks By Design Commercial |
$177.40
|
| Rate for Payer: Prime Health Services Commercial |
$231.99
|
| Rate for Payer: Riverside University Health System MISP |
$109.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.47
|
| Rate for Payer: United Healthcare All Other HMO |
$136.47
|
| Rate for Payer: United Healthcare HMO Rider |
$136.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.99
|
| Rate for Payer: Vantage Medical Group Senior |
$231.99
|
|
|
HC CATH UMBILICAL VESSEL 5.0FR
|
Facility
|
OP
|
$272.86
|
|
| Hospital Charge Code |
901603823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$245.57 |
| Rate for Payer: Adventist Health Commercial |
$54.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.25
|
| Rate for Payer: Blue Shield of California Commercial |
$166.72
|
| Rate for Payer: Blue Shield of California EPN |
$108.87
|
| Rate for Payer: Cash Price |
$150.07
|
| Rate for Payer: Central Health Plan Commercial |
$218.29
|
| Rate for Payer: Cigna of CA HMO |
$174.63
|
| Rate for Payer: Cigna of CA PPO |
$201.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.14
|
| Rate for Payer: EPIC Health Plan Senior |
$109.14
|
| Rate for Payer: Galaxy Health WC |
$231.93
|
| Rate for Payer: Global Benefits Group Commercial |
$163.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.57
|
| Rate for Payer: InnovAge PACE Commercial |
$136.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.00
|
| Rate for Payer: Multiplan Commercial |
$204.65
|
| Rate for Payer: Networks By Design Commercial |
$177.36
|
| Rate for Payer: Prime Health Services Commercial |
$231.93
|
| Rate for Payer: Riverside University Health System MISP |
$109.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.43
|
| Rate for Payer: United Healthcare All Other HMO |
$136.43
|
| Rate for Payer: United Healthcare HMO Rider |
$136.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.93
|
| Rate for Payer: Vantage Medical Group Senior |
$231.93
|
|
|
HC CATH UMBILICAL VESSEL 5.0FR
|
Facility
|
IP
|
$272.86
|
|
| Hospital Charge Code |
901603823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$245.57 |
| Rate for Payer: Adventist Health Commercial |
$54.57
|
| Rate for Payer: Cash Price |
$150.07
|
| Rate for Payer: Central Health Plan Commercial |
$218.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.14
|
| Rate for Payer: EPIC Health Plan Senior |
$109.14
|
| Rate for Payer: Galaxy Health WC |
$231.93
|
| Rate for Payer: Global Benefits Group Commercial |
$163.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.57
|
| Rate for Payer: Multiplan Commercial |
$204.65
|
| Rate for Payer: Networks By Design Commercial |
$177.36
|
| Rate for Payer: Prime Health Services Commercial |
$231.93
|
|
|
HC CATH URETHRAL 14FR PVC
|
Facility
|
IP
|
$3.69
|
|
| Hospital Charge Code |
901698527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
|
|
HC CATH URETHRAL 14FR PVC
|
Facility
|
OP
|
$3.69
|
|
| Hospital Charge Code |
901698527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.36
|
| Rate for Payer: Cigna of CA PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: InnovAge PACE Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Riverside University Health System MISP |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
HC CATH URETHRAL PVP KIT 14FR
|
Facility
|
OP
|
$20.66
|
|
| Hospital Charge Code |
901698633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.62
|
| Rate for Payer: Blue Shield of California EPN |
$8.24
|
| Rate for Payer: Cash Price |
$11.36
|
| Rate for Payer: Central Health Plan Commercial |
$16.53
|
| Rate for Payer: Cigna of CA HMO |
$13.22
|
| Rate for Payer: Cigna of CA PPO |
$15.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.59
|
| Rate for Payer: InnovAge PACE Commercial |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$15.49
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.56
|
| Rate for Payer: Vantage Medical Group Senior |
$17.56
|
|
|
HC CATH URETHRAL PVP KIT 14FR
|
Facility
|
IP
|
$20.66
|
|
| Hospital Charge Code |
901698633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$11.36
|
| Rate for Payer: Central Health Plan Commercial |
$16.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$15.49
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
|
|
HC CATH URETHRAL REDRUBBER 10FR
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
|
|
HC CATH URETHRAL REDRUBBER 10FR
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.41
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Riverside University Health System MISP |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC CATH URETHRAL REDRUBBER 12FR
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
|
|
HC CATH URETHRAL REDRUBBER 12FR
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.41
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Riverside University Health System MISP |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC CATH URETHRAL REDRUBBER 14FR
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC CATH URETHRAL REDRUBBER 14FR
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: InnovAge PACE Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC CATH URETHRAL REDRUBBER 16FR
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.41
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Riverside University Health System MISP |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC CATH URETHRAL REDRUBBER 16FR
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
|
|
HC CATH URETHRAL REDRUBBER 18FR
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
|
|
HC CATH URETHRAL REDRUBBER 18FR
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.41
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Riverside University Health System MISP |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC CATH URETHRAL REDRUBBER 20FR
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
901607397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.41
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Riverside University Health System MISP |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
