|
HC INDR MED FLEXCATH STEERABLE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1766
|
| Hospital Charge Code |
906812545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC INDR MED MICRA MI1255A
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| 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 |
$1,521.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
|
|
HC INDR MED MICRA MI1255A
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,421.08
|
| 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 |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,133.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,374.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,429.74
|
| Rate for Payer: Blue Shield of California EPN |
$933.66
|
| 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 |
$1,497.60
|
| Rate for Payer: Cigna of CA PPO |
$1,731.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,989.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$1,170.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,638.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: Networks By Design Commercial |
$1,521.00
|
| 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 Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC INDR MERIT CLASSIC SHEATH 13CM
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$213.85
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC INDR MERIT CLASSIC SHEATH 13CM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC INDR MERIT CLASSIC SHEATH 25CM
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
|
|
HC INDR MERIT CLASSIC SHEATH 25CM
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$281.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$224.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.51
|
| Rate for Payer: Blue Shield of California Commercial |
$283.50
|
| Rate for Payer: Blue Shield of California EPN |
$185.14
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: Cigna of CA HMO |
$296.96
|
| Rate for Payer: Cigna of CA PPO |
$343.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$394.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$394.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: InnovAge PACE Commercial |
$232.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.80
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Riverside University Health System MISP |
$185.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$232.00
|
| Rate for Payer: United Healthcare All Other HMO |
$232.00
|
| Rate for Payer: United Healthcare HMO Rider |
$232.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$394.40
|
| Rate for Payer: Vantage Medical Group Senior |
$394.40
|
|
|
HC INDR MERIT PRELUDE SNAP 13CM
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Central Health Plan Commercial |
$263.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$296.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$246.75
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
|
|
HC INDR MERIT PRELUDE SNAP 13CM
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$159.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.22
|
| Rate for Payer: Blue Shield of California Commercial |
$201.02
|
| Rate for Payer: Blue Shield of California EPN |
$131.27
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Central Health Plan Commercial |
$263.20
|
| Rate for Payer: Cigna of CA HMO |
$210.56
|
| Rate for Payer: Cigna of CA PPO |
$243.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$279.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$279.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$279.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$296.10
|
| Rate for Payer: InnovAge PACE Commercial |
$164.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$230.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$230.30
|
| Rate for Payer: Multiplan Commercial |
$246.75
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
| Rate for Payer: Riverside University Health System MISP |
$131.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$197.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$197.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.50
|
| Rate for Payer: United Healthcare All Other HMO |
$164.50
|
| Rate for Payer: United Healthcare HMO Rider |
$164.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$279.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$279.65
|
| Rate for Payer: Vantage Medical Group Senior |
$279.65
|
|
|
HC INDR MERIT PRELUDE SNAP 25CM
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$250.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.55
|
| Rate for Payer: Blue Shield of California Commercial |
$252.34
|
| Rate for Payer: Blue Shield of California EPN |
$164.79
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: Central Health Plan Commercial |
$330.40
|
| Rate for Payer: Cigna of CA HMO |
$264.32
|
| Rate for Payer: Cigna of CA PPO |
$305.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.70
|
| Rate for Payer: InnovAge PACE Commercial |
$206.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.10
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: Riverside University Health System MISP |
$165.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.50
|
| Rate for Payer: United Healthcare All Other HMO |
$206.50
|
| Rate for Payer: United Healthcare HMO Rider |
$206.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.05
|
| Rate for Payer: Vantage Medical Group Senior |
$351.05
|
|
|
HC INDR MERIT PRELUDE SNAP 25CM
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT C1892
|
| Hospital Charge Code |
906812564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: Central Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.60
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.48
|
| Rate for Payer: Blue Shield of California Commercial |
$73.32
|
| Rate for Payer: Blue Shield of California EPN |
$47.88
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: InnovAge PACE Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health System MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC INDR PEDIAVASC SUPER 3.3FR
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.49
|
| Rate for Payer: Blue Shield of California Commercial |
$24.44
|
| Rate for Payer: Blue Shield of California EPN |
$15.96
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: InnovAge PACE Commercial |
$20.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Riverside University Health System MISP |
$16.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC INDR PEDIAVASC SUPER 3.3FR
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$393.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$486.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.57
|
| Rate for Payer: Blue Shield of California Commercial |
$395.93
|
| Rate for Payer: Blue Shield of California EPN |
$258.55
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Cigna of CA HMO |
$414.72
|
| Rate for Payer: Cigna of CA PPO |
$479.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$550.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$550.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: InnovAge PACE Commercial |
$324.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$401.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$453.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Riverside University Health System MISP |
$259.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$324.00
|
| Rate for Payer: United Healthcare HMO Rider |
$324.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$550.80
|
| Rate for Payer: Vantage Medical Group Senior |
$550.80
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$401.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
|
|
HC INDR SPECT LASER GLIDELIGHT
|
Facility
|
IP
|
$7,238.00
|
|
|
Service Code
|
CPT C2629
|
| Hospital Charge Code |
906812680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,895.20
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,757.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,480.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
|
|
HC INDR SPECT LASER GLIDELIGHT
|
Facility
|
OP
|
$7,238.00
|
|
|
Service Code
|
CPT C2629
|
| Hospital Charge Code |
906812680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,395.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,152.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,980.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,428.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,504.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,250.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4,422.42
|
| Rate for Payer: Blue Shield of California EPN |
$2,887.96
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: Cigna of CA HMO |
$4,632.32
|
| Rate for Payer: Cigna of CA PPO |
$5,356.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,152.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,152.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,152.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,895.20
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: InnovAge PACE Commercial |
$3,619.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,757.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,480.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,066.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,066.60
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,895.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,342.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,342.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,619.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,619.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,619.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,152.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,152.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,152.30
|
|
|
HC INDR SPECT TIGHTRAIL DILA MINI
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC INDR SPECT TIGHTRAIL DILA MINI
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC INDR SPECT TIGHTRAIL DILATOR
|
Facility
|
IP
|
$4,738.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$4,264.20 |
| Rate for Payer: Adventist Health Commercial |
$947.60
|
| Rate for Payer: Cash Price |
$2,132.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,790.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,895.20
|
| Rate for Payer: Galaxy Health WC |
$4,027.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,264.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,160.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,932.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.60
|
| Rate for Payer: Multiplan Commercial |
$3,553.50
|
| Rate for Payer: Networks By Design Commercial |
$3,079.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,027.30
|
|
|
HC INDR SPECT TIGHTRAIL DILATOR
|
Facility
|
OP
|
$4,738.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$4,264.20 |
| Rate for Payer: Adventist Health Commercial |
$947.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,877.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,027.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,605.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,553.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,294.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,782.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,894.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,890.46
|
| Rate for Payer: Cash Price |
$2,132.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,790.40
|
| Rate for Payer: Cigna of CA HMO |
$3,032.32
|
| Rate for Payer: Cigna of CA PPO |
$3,506.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,027.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,027.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,027.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,895.20
|
| Rate for Payer: Galaxy Health WC |
$4,027.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,264.20
|
| Rate for Payer: InnovAge PACE Commercial |
$2,369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,160.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,932.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,316.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,316.60
|
| Rate for Payer: Multiplan Commercial |
$3,553.50
|
| Rate for Payer: Networks By Design Commercial |
$3,079.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,027.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,895.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,842.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,842.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,027.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,027.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,027.30
|
|
|
HC INDR SPECT TIGHTRAIL SUB-C
|
Facility
|
OP
|
$4,238.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,814.20 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,573.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,330.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,178.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,052.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,488.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,589.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,690.96
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,390.40
|
| Rate for Payer: Cigna of CA HMO |
$2,712.32
|
| Rate for Payer: Cigna of CA PPO |
$3,136.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,602.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,602.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,814.20
|
| Rate for Payer: InnovAge PACE Commercial |
$2,119.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,966.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,966.60
|
| Rate for Payer: Multiplan Commercial |
$3,178.50
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,695.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,542.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,542.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,119.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,119.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,602.30
|
|
|
HC INDR SPECT TIGHTRAIL SUB-C
|
Facility
|
IP
|
$4,238.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,814.20 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,390.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,814.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.60
|
| Rate for Payer: Multiplan Commercial |
$3,178.50
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
|
