|
HC CATH BALLOON DRUG COATED
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
909081859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.00 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,536.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.00
|
| Rate for Payer: Cigna of CA HMO |
$3,325.00
|
| Rate for Payer: Cigna of CA PPO |
$3,325.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,809.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.00
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,793.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,751.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1,713.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,567.50
|
|
|
HC CATH BALLOON DRUG COATED
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
909081859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.00 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,612.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,168.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,645.75
|
| Rate for Payer: Blue Distinction Transplant |
$2,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,562.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,584.00
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.00
|
| Rate for Payer: Cigna of CA HMO |
$3,325.00
|
| Rate for Payer: Cigna of CA PPO |
$3,325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Media |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,900.00
|
| Rate for Payer: Galaxy Health WC |
$4,037.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,562.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,662.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,809.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.00
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| Rate for Payer: Networks By Design Commercial |
$2,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,037.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,900.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,850.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,375.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC CATH BALLOON PURSUIT
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Blue Shield of California EPN |
$336.42
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Central Health Plan Commercial |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$441.00
|
| Rate for Payer: Cigna of CA PPO |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.89
|
| Rate for Payer: United Healthcare All Other HMO |
$232.34
|
| Rate for Payer: United Healthcare HMO Rider |
$227.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.90
|
|
|
HC CATH BALLOON PURSUIT
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$346.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$346.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$287.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.91
|
| Rate for Payer: Blue Distinction Transplant |
$378.00
|
| Rate for Payer: Blue Shield of California Commercial |
$472.50
|
| Rate for Payer: Blue Shield of California EPN |
$342.72
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Central Health Plan Commercial |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$441.00
|
| Rate for Payer: Cigna of CA PPO |
$441.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$535.50
|
| Rate for Payer: Dignity Health Media |
$535.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$472.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: Networks By Design Commercial |
$315.00
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: Riverside University Health System MISP |
$252.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$315.00
|
| Rate for Payer: United Healthcare All Other HMO |
$315.00
|
| Rate for Payer: United Healthcare HMO Rider |
$315.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$535.50
|
| Rate for Payer: Vantage Medical Group Senior |
$535.50
|
|
|
HC CATH BAYLIS BMC
|
Facility
|
OP
|
$851.00
|
|
| Hospital Charge Code |
906812324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$516.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$468.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$468.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$412.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.77
|
| Rate for Payer: Blue Distinction Transplant |
$510.60
|
| Rate for Payer: Blue Shield of California Commercial |
$535.28
|
| Rate for Payer: Blue Shield of California EPN |
$416.14
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: Cigna of CA HMO |
$544.64
|
| Rate for Payer: Cigna of CA PPO |
$629.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$723.35
|
| Rate for Payer: Dignity Health Media |
$723.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$723.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$638.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$297.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: Riverside University Health System MISP |
$340.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$723.35
|
| Rate for Payer: Vantage Medical Group Senior |
$723.35
|
|
|
HC CATH BAYLIS BMC
|
Facility
|
IP
|
$851.00
|
|
| Hospital Charge Code |
906812324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
|
|
HC CATH BLLN CORDIS MAXI LD
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$643.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.69
|
| Rate for Payer: Blue Distinction Transplant |
$702.00
|
| Rate for Payer: Blue Shield of California Commercial |
$877.50
|
| Rate for Payer: Blue Shield of California EPN |
$636.48
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Cigna of CA HMO |
$819.00
|
| Rate for Payer: Cigna of CA PPO |
$819.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Media |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$877.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$409.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Riverside University Health System MISP |
$468.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$585.00
|
| Rate for Payer: United Healthcare All Other HMO |
$585.00
|
| Rate for Payer: United Healthcare HMO Rider |
$585.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$585.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC CATH BLLN CORDIS MAXI LD
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Blue Shield of California EPN |
$624.78
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Cigna of CA HMO |
$819.00
|
| Rate for Payer: Cigna of CA PPO |
$819.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.79
|
| Rate for Payer: United Healthcare All Other HMO |
$431.50
|
| Rate for Payer: United Healthcare HMO Rider |
$422.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$386.10
|
|
|
HC CATH BLLN CORDIS PWRFLEX EXTRM
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$410.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$501.30
|
| Rate for Payer: Blue Distinction Transplant |
$540.00
|
| Rate for Payer: Blue Shield of California Commercial |
$675.00
|
| Rate for Payer: Blue Shield of California EPN |
$489.60
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$630.00
|
| Rate for Payer: Cigna of CA PPO |
$630.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Media |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$450.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: Riverside University Health System MISP |
$360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$450.00
|
| Rate for Payer: United Healthcare HMO Rider |
$450.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC CATH BLLN CORDIS PWRFLEX EXTRM
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Blue Shield of California EPN |
$480.60
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$630.00
|
| Rate for Payer: Cigna of CA PPO |
$630.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Other HMO |
$331.92
|
| Rate for Payer: United Healthcare HMO Rider |
$324.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.00
|
|
|
HC CATH BLLN JUPITER PTA
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,249.56
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$883.58
|
| Rate for Payer: United Healthcare All Other HMO |
$862.99
|
| Rate for Payer: United Healthcare HMO Rider |
$844.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$772.20
|
|
|
HC CATH BLLN JUPITER PTA
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,068.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.38
|
| Rate for Payer: Blue Distinction Transplant |
$1,404.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,755.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,272.96
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Media |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,755.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$819.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: Riverside University Health System MISP |
$936.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,404.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,170.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC CATH BLLN URETHRAL COOK
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901692022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Blue Shield of California EPN |
$309.72
|
| Rate for Payer: Cash Price |
$261.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.01
|
| Rate for Payer: United Healthcare All Other HMO |
$213.90
|
| Rate for Payer: United Healthcare HMO Rider |
$209.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
|
|
HC CATH BLLN URETHRAL COOK
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901692022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| 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 |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.06
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$435.00
|
| Rate for Payer: Blue Shield of California EPN |
$315.52
|
| Rate for Payer: Cash Price |
$261.00
|
| 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 Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| 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: 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: 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 |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CATH BRAUN MULTI TRACK 5FR
|
Facility
|
OP
|
$250.67
|
|
| Hospital Charge Code |
906812268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$152.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.10
|
| Rate for Payer: Blue Distinction Transplant |
$150.40
|
| Rate for Payer: Blue Shield of California Commercial |
$157.67
|
| Rate for Payer: Blue Shield of California EPN |
$122.58
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Central Health Plan Commercial |
$200.54
|
| Rate for Payer: Cigna of CA HMO |
$160.43
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.07
|
| Rate for Payer: Dignity Health Media |
$213.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.27
|
| Rate for Payer: Galaxy Health WC |
$213.07
|
| Rate for Payer: Global Benefits Group Commercial |
$150.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$188.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.13
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$162.94
|
| Rate for Payer: Prime Health Services Commercial |
$213.07
|
| Rate for Payer: Riverside University Health System MISP |
$100.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.34
|
| Rate for Payer: United Healthcare All Other HMO |
$125.34
|
| Rate for Payer: United Healthcare HMO Rider |
$125.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.07
|
| Rate for Payer: Vantage Medical Group Senior |
$213.07
|
|
|
HC CATH BRAUN MULTI TRACK 5FR
|
Facility
|
IP
|
$250.67
|
|
| Hospital Charge Code |
906812268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Central Health Plan Commercial |
$200.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.27
|
| Rate for Payer: Galaxy Health WC |
$213.07
|
| Rate for Payer: Global Benefits Group Commercial |
$150.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.13
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$162.94
|
| Rate for Payer: Prime Health Services Commercial |
$213.07
|
|
|
HC CATH BRAUN MULTI TRACK 6FR
|
Facility
|
IP
|
$303.80
|
|
| Hospital Charge Code |
906812437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Cash Price |
$136.71
|
| Rate for Payer: Central Health Plan Commercial |
$243.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.52
|
| Rate for Payer: Galaxy Health WC |
$258.23
|
| Rate for Payer: Global Benefits Group Commercial |
$182.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.76
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: Networks By Design Commercial |
$197.47
|
| Rate for Payer: Prime Health Services Commercial |
$258.23
|
|
|
HC CATH BRAUN MULTI TRACK 6FR
|
Facility
|
OP
|
$303.80
|
|
| Hospital Charge Code |
906812437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$184.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.49
|
| Rate for Payer: Blue Distinction Transplant |
$182.28
|
| Rate for Payer: Blue Shield of California Commercial |
$191.09
|
| Rate for Payer: Blue Shield of California EPN |
$148.56
|
| Rate for Payer: Cash Price |
$136.71
|
| Rate for Payer: Central Health Plan Commercial |
$243.04
|
| Rate for Payer: Cigna of CA HMO |
$194.43
|
| Rate for Payer: Cigna of CA PPO |
$224.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.23
|
| Rate for Payer: Dignity Health Media |
$258.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.52
|
| Rate for Payer: Galaxy Health WC |
$258.23
|
| Rate for Payer: Global Benefits Group Commercial |
$182.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$227.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.76
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: Networks By Design Commercial |
$197.47
|
| Rate for Payer: Prime Health Services Commercial |
$258.23
|
| Rate for Payer: Riverside University Health System MISP |
$121.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.90
|
| Rate for Payer: United Healthcare All Other HMO |
$151.90
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.23
|
| Rate for Payer: Vantage Medical Group Senior |
$258.23
|
|
|
HC CATH BROVIAC 4.2FR 90CM PEDS
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901603657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,394.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,157.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,901.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,379.04
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Media |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,901.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$887.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC CATH BROVIAC 4.2FR 90CM PEDS
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901603657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Blue Shield of California EPN |
$1,353.69
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$957.22
|
| Rate for Payer: United Healthcare All Other HMO |
$934.91
|
| Rate for Payer: United Healthcare HMO Rider |
$914.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$836.55
|
|
|
HC CATH BROVIAC 4.2FR WH
|
Facility
|
OP
|
$869.40
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$782.46 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$478.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$396.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$484.26
|
| Rate for Payer: Blue Distinction Transplant |
$521.64
|
| Rate for Payer: Blue Shield of California Commercial |
$652.05
|
| Rate for Payer: Blue Shield of California EPN |
$472.95
|
| Rate for Payer: Cash Price |
$391.23
|
| Rate for Payer: Central Health Plan Commercial |
$695.52
|
| Rate for Payer: Cigna of CA HMO |
$608.58
|
| Rate for Payer: Cigna of CA PPO |
$608.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.99
|
| Rate for Payer: Dignity Health Media |
$738.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$347.76
|
| Rate for Payer: Galaxy Health WC |
$738.99
|
| Rate for Payer: Global Benefits Group Commercial |
$521.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$652.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$652.05
|
| Rate for Payer: Networks By Design Commercial |
$434.70
|
| Rate for Payer: Prime Health Services Commercial |
$738.99
|
| Rate for Payer: Riverside University Health System MISP |
$347.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.70
|
| Rate for Payer: United Healthcare All Other HMO |
$434.70
|
| Rate for Payer: United Healthcare HMO Rider |
$434.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.99
|
| Rate for Payer: Vantage Medical Group Senior |
$738.99
|
|
|
HC CATH BROVIAC 4.2FR WH
|
Facility
|
IP
|
$869.40
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901605603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$782.46 |
| Rate for Payer: Blue Shield of California EPN |
$464.26
|
| Rate for Payer: Cash Price |
$391.23
|
| Rate for Payer: Central Health Plan Commercial |
$695.52
|
| Rate for Payer: Cigna of CA HMO |
$608.58
|
| Rate for Payer: Cigna of CA PPO |
$608.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$347.76
|
| Rate for Payer: Galaxy Health WC |
$738.99
|
| Rate for Payer: Global Benefits Group Commercial |
$521.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$652.05
|
| Rate for Payer: Prime Health Services Commercial |
$738.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.29
|
| Rate for Payer: United Healthcare All Other HMO |
$320.63
|
| Rate for Payer: United Healthcare HMO Rider |
$313.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.90
|
|
|
HC CATH B/S RENEGADE MICRO
|
Facility
|
IP
|
$2,106.34
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.27 |
| Max. Negotiated Rate |
$1,895.71 |
| Rate for Payer: Cash Price |
$947.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,685.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$1,790.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,263.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,895.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,404.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$802.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.27
|
| Rate for Payer: Multiplan Commercial |
$1,579.76
|
| Rate for Payer: Networks By Design Commercial |
$1,369.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,790.39
|
|
|
HC CATH B/S RENEGADE MICRO
|
Facility
|
OP
|
$2,106.34
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$1,895.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,790.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,158.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,019.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,244.43
|
| Rate for Payer: Blue Distinction Transplant |
$1,263.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,324.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.00
|
| Rate for Payer: Cash Price |
$947.85
|
| Rate for Payer: Cash Price |
$947.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,685.07
|
| Rate for Payer: Cigna of CA HMO |
$1,348.06
|
| Rate for Payer: Cigna of CA PPO |
$1,558.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,790.39
|
| Rate for Payer: Dignity Health Media |
$1,790.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,790.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$842.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$1,790.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,263.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,895.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,579.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$737.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,404.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$802.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.27
|
| Rate for Payer: Multiplan Commercial |
$1,579.76
|
| Rate for Payer: Networks By Design Commercial |
$1,369.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,790.39
|
| Rate for Payer: Riverside University Health System MISP |
$842.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,263.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,263.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,053.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1,053.17
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,790.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,790.39
|
|
|
HC CATH CATALYST THROM
|
Facility
|
IP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,003.75
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,143.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,124.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,074.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,029.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,856.25
|
|
