|
HC KIT CATH HICKMAN RPR 12FR
|
Facility
|
IP
|
$2,636.40
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.28 |
| Max. Negotiated Rate |
$2,372.76 |
| Rate for Payer: Adventist Health Commercial |
$527.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,037.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,328.75
|
| Rate for Payer: Cash Price |
$1,450.02
|
| Rate for Payer: Central Health Plan Commercial |
$2,109.12
|
| Rate for Payer: Cigna of CA HMO |
$1,845.48
|
| Rate for Payer: Cigna of CA PPO |
$1,845.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,054.56
|
| Rate for Payer: EPIC Health Plan Senior |
$1,054.56
|
| Rate for Payer: Galaxy Health WC |
$2,240.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1,581.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,372.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,758.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,004.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,631.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.28
|
| Rate for Payer: Multiplan Commercial |
$1,977.30
|
| Rate for Payer: Networks By Design Commercial |
$1,318.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,240.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$989.44
|
| Rate for Payer: United Healthcare All Other HMO |
$963.08
|
| Rate for Payer: United Healthcare HMO Rider |
$942.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$863.42
|
|
|
HC KIT CATH HMDYLYS 7FR SHORT TM
|
Facility
|
IP
|
$402.29
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$362.06 |
| Rate for Payer: Adventist Health Commercial |
$80.46
|
| Rate for Payer: Blue Shield of California Commercial |
$310.97
|
| Rate for Payer: Blue Shield of California EPN |
$202.75
|
| Rate for Payer: Cash Price |
$221.26
|
| Rate for Payer: Central Health Plan Commercial |
$321.83
|
| Rate for Payer: Cigna of CA HMO |
$281.60
|
| Rate for Payer: Cigna of CA PPO |
$281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.92
|
| Rate for Payer: EPIC Health Plan Senior |
$160.92
|
| Rate for Payer: Galaxy Health WC |
$341.95
|
| Rate for Payer: Global Benefits Group Commercial |
$241.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$249.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.46
|
| Rate for Payer: Multiplan Commercial |
$301.72
|
| Rate for Payer: Networks By Design Commercial |
$201.15
|
| Rate for Payer: Prime Health Services Commercial |
$341.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.98
|
| Rate for Payer: United Healthcare All Other HMO |
$146.96
|
| Rate for Payer: United Healthcare HMO Rider |
$143.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.75
|
|
|
HC KIT CATH HMDYLYS 7FR SHORT TM
|
Facility
|
OP
|
$402.29
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$362.06 |
| Rate for Payer: Adventist Health Commercial |
$80.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$341.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$221.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.75
|
| Rate for Payer: Blue Shield of California Commercial |
$310.97
|
| Rate for Payer: Blue Shield of California EPN |
$202.75
|
| Rate for Payer: Cash Price |
$221.26
|
| Rate for Payer: Central Health Plan Commercial |
$321.83
|
| Rate for Payer: Cigna of CA HMO |
$281.60
|
| Rate for Payer: Cigna of CA PPO |
$281.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$341.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$341.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.92
|
| Rate for Payer: EPIC Health Plan Senior |
$160.92
|
| Rate for Payer: Galaxy Health WC |
$341.95
|
| Rate for Payer: Global Benefits Group Commercial |
$241.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.06
|
| Rate for Payer: InnovAge PACE Commercial |
$201.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$249.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$281.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$281.60
|
| Rate for Payer: Multiplan Commercial |
$301.72
|
| Rate for Payer: Networks By Design Commercial |
$201.15
|
| Rate for Payer: Prime Health Services Commercial |
$341.95
|
| Rate for Payer: Riverside University Health System MISP |
$160.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.98
|
| Rate for Payer: United Healthcare All Other HMO |
$146.96
|
| Rate for Payer: United Healthcare HMO Rider |
$143.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$341.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.95
|
| Rate for Payer: Vantage Medical Group Senior |
$341.95
|
|
|
HC KIT CATH ICP 4FR LICOX
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
901695701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,350.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,405.30
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC KIT CATH ICP 4FR LICOX
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
901695701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC KIT CATH ICP 4FR LICOX+IT2
|
Facility
|
IP
|
$2,910.18
|
|
| Hospital Charge Code |
901695702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.04 |
| Max. Negotiated Rate |
$2,619.16 |
| Rate for Payer: Adventist Health Commercial |
$582.04
|
| Rate for Payer: Cash Price |
$1,600.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,328.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,164.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1,164.07
|
| Rate for Payer: Galaxy Health WC |
$2,473.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,746.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,619.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,941.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,108.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,801.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.04
|
| Rate for Payer: Multiplan Commercial |
$2,182.64
|
| Rate for Payer: Networks By Design Commercial |
$1,891.62
|
| Rate for Payer: Prime Health Services Commercial |
$2,473.65
|
|
|
HC KIT CATH ICP 4FR LICOX+IT2
|
Facility
|
OP
|
$2,910.18
|
|
| Hospital Charge Code |
901695702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.04 |
| Max. Negotiated Rate |
$2,619.16 |
| Rate for Payer: Adventist Health Commercial |
$582.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,767.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,473.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,600.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,182.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,409.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,709.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,778.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,161.16
|
| Rate for Payer: Cash Price |
$1,600.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,328.14
|
| Rate for Payer: Cigna of CA HMO |
$1,862.52
|
| Rate for Payer: Cigna of CA PPO |
$2,153.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,473.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,473.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,473.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,164.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1,164.07
|
| Rate for Payer: Galaxy Health WC |
$2,473.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,746.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,619.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,455.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,941.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,108.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,801.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,037.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,037.13
|
| Rate for Payer: Multiplan Commercial |
$2,182.64
|
| Rate for Payer: Networks By Design Commercial |
$1,891.62
|
| Rate for Payer: Prime Health Services Commercial |
$2,473.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,164.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,746.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,746.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1,455.09
|
| Rate for Payer: United Healthcare HMO Rider |
$1,455.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,455.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,473.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,473.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,473.65
|
|
|
HC KIT CATH ICP CAMINO 4FR
|
Facility
|
OP
|
$2,610.00
|
|
| Hospital Charge Code |
901602360
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$2,349.00 |
| Rate for Payer: Adventist Health Commercial |
$522.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,585.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,435.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,957.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,263.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,532.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,594.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,041.39
|
| Rate for Payer: Cash Price |
$1,435.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,088.00
|
| Rate for Payer: Cigna of CA HMO |
$1,670.40
|
| Rate for Payer: Cigna of CA PPO |
$1,931.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,218.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,349.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,305.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$994.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,615.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,827.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,827.00
|
| Rate for Payer: Multiplan Commercial |
$1,957.50
|
| Rate for Payer: Networks By Design Commercial |
$1,696.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,044.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,566.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,566.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,305.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,218.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,218.50
|
|
|
HC KIT CATH ICP CAMINO 4FR
|
Facility
|
IP
|
$2,610.00
|
|
| Hospital Charge Code |
901602360
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$2,349.00 |
| Rate for Payer: Adventist Health Commercial |
$522.00
|
| Rate for Payer: Cash Price |
$1,435.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,088.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,349.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$994.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,615.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,957.50
|
| Rate for Payer: Networks By Design Commercial |
$1,696.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
|
|
HC KIT CATH INTRAAORTIC 8FR 30CC
|
Facility
|
IP
|
$3,373.50
|
|
| Hospital Charge Code |
901605517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$674.70 |
| Max. Negotiated Rate |
$3,036.15 |
| Rate for Payer: Adventist Health Commercial |
$674.70
|
| Rate for Payer: Cash Price |
$1,855.43
|
| Rate for Payer: Central Health Plan Commercial |
$2,698.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,349.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,349.40
|
| Rate for Payer: Galaxy Health WC |
$2,867.47
|
| Rate for Payer: Global Benefits Group Commercial |
$2,024.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,036.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,250.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,088.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.70
|
| Rate for Payer: Multiplan Commercial |
$2,530.12
|
| Rate for Payer: Networks By Design Commercial |
$2,192.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,867.47
|
|
|
HC KIT CATH INTRAAORTIC 8FR 30CC
|
Facility
|
OP
|
$3,373.50
|
|
| Hospital Charge Code |
901605517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$674.70 |
| Max. Negotiated Rate |
$3,036.15 |
| Rate for Payer: Adventist Health Commercial |
$674.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,048.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,867.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,855.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,530.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,633.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,981.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,061.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,346.03
|
| Rate for Payer: Cash Price |
$1,855.43
|
| Rate for Payer: Central Health Plan Commercial |
$2,698.80
|
| Rate for Payer: Cigna of CA HMO |
$2,159.04
|
| Rate for Payer: Cigna of CA PPO |
$2,496.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,867.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,867.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,867.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,349.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,349.40
|
| Rate for Payer: Galaxy Health WC |
$2,867.47
|
| Rate for Payer: Global Benefits Group Commercial |
$2,024.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,036.15
|
| Rate for Payer: InnovAge PACE Commercial |
$1,686.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,250.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,088.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,361.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,361.45
|
| Rate for Payer: Multiplan Commercial |
$2,530.12
|
| Rate for Payer: Networks By Design Commercial |
$2,192.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,867.47
|
| Rate for Payer: Riverside University Health System MISP |
$1,349.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,024.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,024.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,686.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,686.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,686.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,686.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,867.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,867.47
|
| Rate for Payer: Vantage Medical Group Senior |
$2,867.47
|
|
|
HC KIT CATH INTRAAORTIC 8FR 30CC
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
901605379
|
|
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 |
$2,145.00
|
| 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 KIT CATH INTRAAORTIC 8FR 30CC
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
901605379
|
|
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 |
$2,145.00
|
| 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 KIT CATH INTRAAORTIC 8FR 40CC
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
901605380
|
|
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 |
$2,145.00
|
| 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 KIT CATH INTRAAORTIC 8FR 40CC
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
901605380
|
|
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 |
$2,145.00
|
| 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 KIT CATH MAHURKAR 11.5FR
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC KIT CATH MAHURKAR 11.5FR
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901603769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.15
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC KIT CATH NEONATAL 5FR PVP
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
CPT A4311
|
| Hospital Charge Code |
901607343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Adventist Health Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Central Health Plan Commercial |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.59
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: Galaxy Health WC |
$14.01
|
| Rate for Payer: Global Benefits Group Commercial |
$9.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$12.36
|
| Rate for Payer: Networks By Design Commercial |
$10.71
|
| Rate for Payer: Prime Health Services Commercial |
$14.01
|
|
|
HC KIT CATH NEONATAL 5FR PVP
|
Facility
|
OP
|
$16.48
|
|
|
Service Code
|
CPT A4311
|
| Hospital Charge Code |
901607343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Adventist Health Commercial |
$3.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.68
|
| Rate for Payer: Blue Shield of California Commercial |
$10.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.58
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Central Health Plan Commercial |
$13.18
|
| Rate for Payer: Cigna of CA HMO |
$10.55
|
| Rate for Payer: Cigna of CA PPO |
$12.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.59
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: Galaxy Health WC |
$14.01
|
| Rate for Payer: Global Benefits Group Commercial |
$9.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.83
|
| Rate for Payer: InnovAge PACE Commercial |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$12.36
|
| Rate for Payer: Networks By Design Commercial |
$10.71
|
| Rate for Payer: Prime Health Services Commercial |
$14.01
|
| Rate for Payer: Riverside University Health System MISP |
$6.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.01
|
| Rate for Payer: Vantage Medical Group Senior |
$14.01
|
|
|
HC KIT, CATH PACING 5FR W/INTRO
|
Facility
|
OP
|
$204.89
|
|
| Hospital Charge Code |
901607989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$184.40 |
| Rate for Payer: Adventist Health Commercial |
$40.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.33
|
| Rate for Payer: Blue Shield of California Commercial |
$125.19
|
| Rate for Payer: Blue Shield of California EPN |
$81.75
|
| Rate for Payer: Cash Price |
$112.69
|
| Rate for Payer: Central Health Plan Commercial |
$163.91
|
| Rate for Payer: Cigna of CA HMO |
$131.13
|
| Rate for Payer: Cigna of CA PPO |
$151.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$174.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$174.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.96
|
| Rate for Payer: EPIC Health Plan Senior |
$81.96
|
| Rate for Payer: Galaxy Health WC |
$174.16
|
| Rate for Payer: Global Benefits Group Commercial |
$122.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.40
|
| Rate for Payer: InnovAge PACE Commercial |
$102.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.42
|
| Rate for Payer: Multiplan Commercial |
$153.67
|
| Rate for Payer: Networks By Design Commercial |
$133.18
|
| Rate for Payer: Prime Health Services Commercial |
$174.16
|
| Rate for Payer: Riverside University Health System MISP |
$81.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$102.44
|
| Rate for Payer: United Healthcare HMO Rider |
$102.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$174.16
|
| Rate for Payer: Vantage Medical Group Senior |
$174.16
|
|
|
HC KIT, CATH PACING 5FR W/INTRO
|
Facility
|
IP
|
$204.89
|
|
| Hospital Charge Code |
901607989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$184.40 |
| Rate for Payer: Adventist Health Commercial |
$40.98
|
| Rate for Payer: Cash Price |
$112.69
|
| Rate for Payer: Central Health Plan Commercial |
$163.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.96
|
| Rate for Payer: EPIC Health Plan Senior |
$81.96
|
| Rate for Payer: Galaxy Health WC |
$174.16
|
| Rate for Payer: Global Benefits Group Commercial |
$122.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.98
|
| Rate for Payer: Multiplan Commercial |
$153.67
|
| Rate for Payer: Networks By Design Commercial |
$133.18
|
| Rate for Payer: Prime Health Services Commercial |
$174.16
|
|
|
HC KIT CATH PEDIATRIC 8FR PVP
|
Facility
|
IP
|
$15.42
|
|
|
Service Code
|
CPT A4311
|
| Hospital Charge Code |
901607342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$13.88 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Central Health Plan Commercial |
$12.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.17
|
| Rate for Payer: Galaxy Health WC |
$13.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.11
|
|
|
HC KIT CATH PEDIATRIC 8FR PVP
|
Facility
|
OP
|
$15.42
|
|
|
Service Code
|
CPT A4311
|
| Hospital Charge Code |
901607342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$13.88 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.06
|
| Rate for Payer: Blue Shield of California Commercial |
$9.42
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Central Health Plan Commercial |
$12.34
|
| Rate for Payer: Cigna of CA HMO |
$9.87
|
| Rate for Payer: Cigna of CA PPO |
$11.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.17
|
| Rate for Payer: Galaxy Health WC |
$13.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.88
|
| Rate for Payer: InnovAge PACE Commercial |
$7.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.11
|
| Rate for Payer: Riverside University Health System MISP |
$6.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.71
|
| Rate for Payer: United Healthcare All Other HMO |
$7.71
|
| Rate for Payer: United Healthcare HMO Rider |
$7.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.11
|
|
|
HC KIT CATH U-BND 2LUM 12FRX16CM
|
Facility
|
OP
|
$692.71
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.54 |
| Max. Negotiated Rate |
$623.44 |
| Rate for Payer: Adventist Health Commercial |
$138.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$380.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$519.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.55
|
| Rate for Payer: Blue Shield of California Commercial |
$535.46
|
| Rate for Payer: Blue Shield of California EPN |
$349.13
|
| Rate for Payer: Cash Price |
$380.99
|
| Rate for Payer: Central Health Plan Commercial |
$554.17
|
| Rate for Payer: Cigna of CA HMO |
$484.90
|
| Rate for Payer: Cigna of CA PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$588.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$588.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.08
|
| Rate for Payer: EPIC Health Plan Senior |
$277.08
|
| Rate for Payer: Galaxy Health WC |
$588.80
|
| Rate for Payer: Global Benefits Group Commercial |
$415.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$623.44
|
| Rate for Payer: InnovAge PACE Commercial |
$346.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$428.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$484.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$484.90
|
| Rate for Payer: Multiplan Commercial |
$519.53
|
| Rate for Payer: Networks By Design Commercial |
$346.36
|
| Rate for Payer: Prime Health Services Commercial |
$588.80
|
| Rate for Payer: Riverside University Health System MISP |
$277.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$415.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$415.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.97
|
| Rate for Payer: United Healthcare All Other HMO |
$253.05
|
| Rate for Payer: United Healthcare HMO Rider |
$247.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$588.80
|
| Rate for Payer: Vantage Medical Group Senior |
$588.80
|
|
|
HC KIT CATH U-BND 2LUM 12FRX16CM
|
Facility
|
IP
|
$692.71
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.54 |
| Max. Negotiated Rate |
$623.44 |
| Rate for Payer: Adventist Health Commercial |
$138.54
|
| Rate for Payer: Blue Shield of California Commercial |
$535.46
|
| Rate for Payer: Blue Shield of California EPN |
$349.13
|
| Rate for Payer: Cash Price |
$380.99
|
| Rate for Payer: Central Health Plan Commercial |
$554.17
|
| Rate for Payer: Cigna of CA HMO |
$484.90
|
| Rate for Payer: Cigna of CA PPO |
$484.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.08
|
| Rate for Payer: EPIC Health Plan Senior |
$277.08
|
| Rate for Payer: Galaxy Health WC |
$588.80
|
| Rate for Payer: Global Benefits Group Commercial |
$415.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$623.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$428.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.54
|
| Rate for Payer: Multiplan Commercial |
$519.53
|
| Rate for Payer: Networks By Design Commercial |
$346.36
|
| Rate for Payer: Prime Health Services Commercial |
$588.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.97
|
| Rate for Payer: United Healthcare All Other HMO |
$253.05
|
| Rate for Payer: United Healthcare HMO Rider |
$247.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.86
|
|
