|
HC KIT CATH U-BND 2LUM 12FRX20CM
|
Facility
|
IP
|
$655.04
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.01 |
| Max. Negotiated Rate |
$589.54 |
| Rate for Payer: Adventist Health Commercial |
$131.01
|
| Rate for Payer: Blue Shield of California Commercial |
$506.35
|
| Rate for Payer: Blue Shield of California EPN |
$330.14
|
| Rate for Payer: Cash Price |
$360.27
|
| Rate for Payer: Central Health Plan Commercial |
$524.03
|
| Rate for Payer: Cigna of CA HMO |
$458.53
|
| Rate for Payer: Cigna of CA PPO |
$458.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.02
|
| Rate for Payer: EPIC Health Plan Senior |
$262.02
|
| Rate for Payer: Galaxy Health WC |
$556.78
|
| Rate for Payer: Global Benefits Group Commercial |
$393.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$589.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.01
|
| Rate for Payer: Multiplan Commercial |
$491.28
|
| Rate for Payer: Networks By Design Commercial |
$327.52
|
| Rate for Payer: Prime Health Services Commercial |
$556.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.84
|
| Rate for Payer: United Healthcare All Other HMO |
$239.29
|
| Rate for Payer: United Healthcare HMO Rider |
$234.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.53
|
|
|
HC KIT CATH U-BND 2LUM 12FRX20CM
|
Facility
|
OP
|
$655.04
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.01 |
| Max. Negotiated Rate |
$589.54 |
| Rate for Payer: Adventist Health Commercial |
$131.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$556.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$360.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.70
|
| Rate for Payer: Blue Shield of California Commercial |
$506.35
|
| Rate for Payer: Blue Shield of California EPN |
$330.14
|
| Rate for Payer: Cash Price |
$360.27
|
| Rate for Payer: Central Health Plan Commercial |
$524.03
|
| Rate for Payer: Cigna of CA HMO |
$458.53
|
| Rate for Payer: Cigna of CA PPO |
$458.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$556.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$556.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$556.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.02
|
| Rate for Payer: EPIC Health Plan Senior |
$262.02
|
| Rate for Payer: Galaxy Health WC |
$556.78
|
| Rate for Payer: Global Benefits Group Commercial |
$393.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$589.54
|
| Rate for Payer: InnovAge PACE Commercial |
$327.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.53
|
| Rate for Payer: Multiplan Commercial |
$491.28
|
| Rate for Payer: Networks By Design Commercial |
$327.52
|
| Rate for Payer: Prime Health Services Commercial |
$556.78
|
| Rate for Payer: Riverside University Health System MISP |
$262.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$393.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.84
|
| Rate for Payer: United Healthcare All Other HMO |
$239.29
|
| Rate for Payer: United Healthcare HMO Rider |
$234.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$556.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$556.78
|
| Rate for Payer: Vantage Medical Group Senior |
$556.78
|
|
|
HC KIT CENTRAL VENOUS 4 LUMEN 8.5 FR,POWER INJ
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607201
|
|
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 CENTRAL VENOUS 4 LUMEN 8.5 FR,POWER INJ
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607201
|
|
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 CENTRAL VENOUS CATHETER MAC 9FR DL W/CURVED SUTURE NEEDLE
|
Facility
|
OP
|
$613.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.67 |
| Max. Negotiated Rate |
$552.02 |
| Rate for Payer: Adventist Health Commercial |
$122.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$460.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$339.62
|
| Rate for Payer: Blue Shield of California Commercial |
$474.13
|
| Rate for Payer: Blue Shield of California EPN |
$309.13
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Central Health Plan Commercial |
$490.69
|
| Rate for Payer: Cigna of CA HMO |
$429.35
|
| Rate for Payer: Cigna of CA PPO |
$429.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.34
|
| Rate for Payer: EPIC Health Plan Senior |
$245.34
|
| Rate for Payer: Galaxy Health WC |
$521.36
|
| Rate for Payer: Global Benefits Group Commercial |
$368.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$552.02
|
| Rate for Payer: InnovAge PACE Commercial |
$306.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$409.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$429.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$429.35
|
| Rate for Payer: Multiplan Commercial |
$460.02
|
| Rate for Payer: Networks By Design Commercial |
$306.68
|
| Rate for Payer: Prime Health Services Commercial |
$521.36
|
| Rate for Payer: Riverside University Health System MISP |
$245.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$368.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.19
|
| Rate for Payer: United Healthcare All Other HMO |
$224.06
|
| Rate for Payer: United Healthcare HMO Rider |
$219.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.36
|
| Rate for Payer: Vantage Medical Group Senior |
$521.36
|
|
|
HC KIT CENTRAL VENOUS CATHETER MAC 9FR DL W/CURVED SUTURE NEEDLE
|
Facility
|
IP
|
$613.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.67 |
| Max. Negotiated Rate |
$552.02 |
| Rate for Payer: Adventist Health Commercial |
$122.67
|
| Rate for Payer: Blue Shield of California Commercial |
$474.13
|
| Rate for Payer: Blue Shield of California EPN |
$309.13
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Central Health Plan Commercial |
$490.69
|
| Rate for Payer: Cigna of CA HMO |
$429.35
|
| Rate for Payer: Cigna of CA PPO |
$429.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.34
|
| Rate for Payer: EPIC Health Plan Senior |
$245.34
|
| Rate for Payer: Galaxy Health WC |
$521.36
|
| Rate for Payer: Global Benefits Group Commercial |
$368.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$552.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$409.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.67
|
| Rate for Payer: Multiplan Commercial |
$460.02
|
| Rate for Payer: Networks By Design Commercial |
$306.68
|
| Rate for Payer: Prime Health Services Commercial |
$521.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.19
|
| Rate for Payer: United Healthcare All Other HMO |
$224.06
|
| Rate for Payer: United Healthcare HMO Rider |
$219.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.88
|
|
|
HC KIT CNTRL LINE CHANGE INFANT
|
Facility
|
OP
|
$96.84
|
|
| Hospital Charge Code |
901698193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$87.16 |
| Rate for Payer: Adventist Health Commercial |
$19.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.87
|
| Rate for Payer: Blue Shield of California Commercial |
$59.17
|
| Rate for Payer: Blue Shield of California EPN |
$38.64
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Central Health Plan Commercial |
$77.47
|
| Rate for Payer: Cigna of CA HMO |
$61.98
|
| Rate for Payer: Cigna of CA PPO |
$71.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.74
|
| Rate for Payer: EPIC Health Plan Senior |
$38.74
|
| Rate for Payer: Galaxy Health WC |
$82.31
|
| Rate for Payer: Global Benefits Group Commercial |
$58.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.16
|
| Rate for Payer: InnovAge PACE Commercial |
$48.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.79
|
| Rate for Payer: Multiplan Commercial |
$72.63
|
| Rate for Payer: Networks By Design Commercial |
$62.95
|
| Rate for Payer: Prime Health Services Commercial |
$82.31
|
| Rate for Payer: Riverside University Health System MISP |
$38.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.42
|
| Rate for Payer: United Healthcare All Other HMO |
$48.42
|
| Rate for Payer: United Healthcare HMO Rider |
$48.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.31
|
| Rate for Payer: Vantage Medical Group Senior |
$82.31
|
|
|
HC KIT CNTRL LINE CHANGE INFANT
|
Facility
|
IP
|
$96.84
|
|
| Hospital Charge Code |
901698193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$87.16 |
| Rate for Payer: Adventist Health Commercial |
$19.37
|
| Rate for Payer: Cash Price |
$53.26
|
| Rate for Payer: Central Health Plan Commercial |
$77.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.74
|
| Rate for Payer: EPIC Health Plan Senior |
$38.74
|
| Rate for Payer: Galaxy Health WC |
$82.31
|
| Rate for Payer: Global Benefits Group Commercial |
$58.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.37
|
| Rate for Payer: Multiplan Commercial |
$72.63
|
| Rate for Payer: Networks By Design Commercial |
$62.95
|
| Rate for Payer: Prime Health Services Commercial |
$82.31
|
|
|
HC KIT CVC/PICC DRSNG CHNG, ADULT
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
901698239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC KIT CVC/PICC DRSNG CHNG, ADULT
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
901698239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.08
|
| Rate for Payer: Blue Shield of California Commercial |
$25.05
|
| Rate for Payer: Blue Shield of California EPN |
$16.36
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: InnovAge PACE Commercial |
$20.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20.50
|
| Rate for Payer: United Healthcare HMO Rider |
$20.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC KIT DRSNG ASPIRA
|
Facility
|
OP
|
$153.72
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901606874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$138.35 |
| Rate for Payer: Adventist Health Commercial |
$30.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.28
|
| Rate for Payer: Blue Shield of California Commercial |
$93.92
|
| Rate for Payer: Blue Shield of California EPN |
$61.33
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Central Health Plan Commercial |
$122.98
|
| Rate for Payer: Cigna of CA HMO |
$98.38
|
| Rate for Payer: Cigna of CA PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.49
|
| Rate for Payer: EPIC Health Plan Senior |
$61.49
|
| Rate for Payer: Galaxy Health WC |
$130.66
|
| Rate for Payer: Global Benefits Group Commercial |
$92.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.35
|
| Rate for Payer: InnovAge PACE Commercial |
$76.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.60
|
| Rate for Payer: Multiplan Commercial |
$115.29
|
| Rate for Payer: Networks By Design Commercial |
$99.92
|
| Rate for Payer: Prime Health Services Commercial |
$130.66
|
| Rate for Payer: Riverside University Health System MISP |
$61.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.86
|
| Rate for Payer: United Healthcare All Other HMO |
$76.86
|
| Rate for Payer: United Healthcare HMO Rider |
$76.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.66
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC KIT DRSNG ASPIRA
|
Facility
|
IP
|
$153.72
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901606874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$138.35 |
| Rate for Payer: Adventist Health Commercial |
$30.74
|
| Rate for Payer: Cash Price |
$84.55
|
| Rate for Payer: Central Health Plan Commercial |
$122.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.49
|
| Rate for Payer: EPIC Health Plan Senior |
$61.49
|
| Rate for Payer: Galaxy Health WC |
$130.66
|
| Rate for Payer: Global Benefits Group Commercial |
$92.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$115.29
|
| Rate for Payer: Networks By Design Commercial |
$99.92
|
| Rate for Payer: Prime Health Services Commercial |
$130.66
|
|
|
HC KIT DRSNG CHANGE PICC CVC
|
Facility
|
OP
|
$280.21
|
|
| Hospital Charge Code |
901698163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.04 |
| Max. Negotiated Rate |
$252.19 |
| Rate for Payer: Adventist Health Commercial |
$56.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.57
|
| Rate for Payer: Blue Shield of California Commercial |
$171.21
|
| Rate for Payer: Blue Shield of California EPN |
$111.80
|
| Rate for Payer: Cash Price |
$154.12
|
| Rate for Payer: Central Health Plan Commercial |
$224.17
|
| Rate for Payer: Cigna of CA HMO |
$179.33
|
| Rate for Payer: Cigna of CA PPO |
$207.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.08
|
| Rate for Payer: EPIC Health Plan Senior |
$112.08
|
| Rate for Payer: Galaxy Health WC |
$238.18
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.19
|
| Rate for Payer: InnovAge PACE Commercial |
$140.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.15
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Networks By Design Commercial |
$182.14
|
| Rate for Payer: Prime Health Services Commercial |
$238.18
|
| Rate for Payer: Riverside University Health System MISP |
$112.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.10
|
| Rate for Payer: United Healthcare All Other HMO |
$140.10
|
| Rate for Payer: United Healthcare HMO Rider |
$140.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.18
|
| Rate for Payer: Vantage Medical Group Senior |
$238.18
|
|
|
HC KIT DRSNG CHANGE PICC CVC
|
Facility
|
IP
|
$280.21
|
|
| Hospital Charge Code |
901698163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.04 |
| Max. Negotiated Rate |
$252.19 |
| Rate for Payer: Adventist Health Commercial |
$56.04
|
| Rate for Payer: Cash Price |
$154.12
|
| Rate for Payer: Central Health Plan Commercial |
$224.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.08
|
| Rate for Payer: EPIC Health Plan Senior |
$112.08
|
| Rate for Payer: Galaxy Health WC |
$238.18
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.04
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Networks By Design Commercial |
$182.14
|
| Rate for Payer: Prime Health Services Commercial |
$238.18
|
|
|
HC KIT IAP MONITOR
|
Facility
|
OP
|
$509.65
|
|
| Hospital Charge Code |
901605588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.93 |
| Max. Negotiated Rate |
$458.69 |
| Rate for Payer: Adventist Health Commercial |
$101.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$309.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$433.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$280.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$382.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$246.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$299.32
|
| Rate for Payer: Blue Shield of California Commercial |
$311.40
|
| Rate for Payer: Blue Shield of California EPN |
$203.35
|
| Rate for Payer: Cash Price |
$280.31
|
| Rate for Payer: Central Health Plan Commercial |
$407.72
|
| Rate for Payer: Cigna of CA HMO |
$326.18
|
| Rate for Payer: Cigna of CA PPO |
$377.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$433.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$433.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$433.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.86
|
| Rate for Payer: EPIC Health Plan Senior |
$203.86
|
| Rate for Payer: Galaxy Health WC |
$433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$305.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.69
|
| Rate for Payer: InnovAge PACE Commercial |
$254.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.75
|
| Rate for Payer: Multiplan Commercial |
$382.24
|
| Rate for Payer: Networks By Design Commercial |
$331.27
|
| Rate for Payer: Prime Health Services Commercial |
$433.20
|
| Rate for Payer: Riverside University Health System MISP |
$203.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.82
|
| Rate for Payer: United Healthcare All Other HMO |
$254.82
|
| Rate for Payer: United Healthcare HMO Rider |
$254.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$433.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$433.20
|
| Rate for Payer: Vantage Medical Group Senior |
$433.20
|
|
|
HC KIT IAP MONITOR
|
Facility
|
IP
|
$509.65
|
|
| Hospital Charge Code |
901605588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.93 |
| Max. Negotiated Rate |
$458.69 |
| Rate for Payer: Adventist Health Commercial |
$101.93
|
| Rate for Payer: Cash Price |
$280.31
|
| Rate for Payer: Central Health Plan Commercial |
$407.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.86
|
| Rate for Payer: EPIC Health Plan Senior |
$203.86
|
| Rate for Payer: Galaxy Health WC |
$433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$305.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.93
|
| Rate for Payer: Multiplan Commercial |
$382.24
|
| Rate for Payer: Networks By Design Commercial |
$331.27
|
| Rate for Payer: Prime Health Services Commercial |
$433.20
|
|
|
HC KIT INDR 3.5FR .018IN X 40CM
|
Facility
|
IP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$272.79 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Central Health Plan Commercial |
$242.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.62
|
| Rate for Payer: Multiplan Commercial |
$227.32
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
|
|
HC KIT INDR 3.5FR .018IN X 40CM
|
Facility
|
OP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$272.79 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.01
|
| Rate for Payer: Blue Shield of California Commercial |
$185.19
|
| Rate for Payer: Blue Shield of California EPN |
$120.94
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Central Health Plan Commercial |
$242.48
|
| Rate for Payer: Cigna of CA HMO |
$193.98
|
| Rate for Payer: Cigna of CA PPO |
$224.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.79
|
| Rate for Payer: InnovAge PACE Commercial |
$151.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.17
|
| Rate for Payer: Multiplan Commercial |
$227.32
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
| Rate for Payer: Riverside University Health System MISP |
$121.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.55
|
| Rate for Payer: United Healthcare All Other HMO |
$151.55
|
| Rate for Payer: United Healthcare HMO Rider |
$151.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.63
|
| Rate for Payer: Vantage Medical Group Senior |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 4FR .018IN DIA X 40CM
|
Facility
|
OP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$272.79 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.01
|
| Rate for Payer: Blue Shield of California Commercial |
$185.19
|
| Rate for Payer: Blue Shield of California EPN |
$120.94
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Central Health Plan Commercial |
$242.48
|
| Rate for Payer: Cigna of CA HMO |
$193.98
|
| Rate for Payer: Cigna of CA PPO |
$224.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.79
|
| Rate for Payer: InnovAge PACE Commercial |
$151.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.17
|
| Rate for Payer: Multiplan Commercial |
$227.32
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
| Rate for Payer: Riverside University Health System MISP |
$121.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.55
|
| Rate for Payer: United Healthcare All Other HMO |
$151.55
|
| Rate for Payer: United Healthcare HMO Rider |
$151.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.63
|
| Rate for Payer: Vantage Medical Group Senior |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 4FR .018IN DIA X 40CM
|
Facility
|
IP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$272.79 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Central Health Plan Commercial |
$242.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.62
|
| Rate for Payer: Multiplan Commercial |
$227.32
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 5FR .018IN DIA X 40CM
|
Facility
|
IP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$272.79 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Central Health Plan Commercial |
$242.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.62
|
| Rate for Payer: Multiplan Commercial |
$227.32
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 5FR .018IN DIA X 40CM
|
Facility
|
OP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$272.79 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.01
|
| Rate for Payer: Blue Shield of California Commercial |
$185.19
|
| Rate for Payer: Blue Shield of California EPN |
$120.94
|
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Central Health Plan Commercial |
$242.48
|
| Rate for Payer: Cigna of CA HMO |
$193.98
|
| Rate for Payer: Cigna of CA PPO |
$224.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.79
|
| Rate for Payer: InnovAge PACE Commercial |
$151.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.17
|
| Rate for Payer: Multiplan Commercial |
$227.32
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
| Rate for Payer: Riverside University Health System MISP |
$121.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.55
|
| Rate for Payer: United Healthcare All Other HMO |
$151.55
|
| Rate for Payer: United Healthcare HMO Rider |
$151.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.63
|
| Rate for Payer: Vantage Medical Group Senior |
$257.63
|
|
|
HC KIT INTRODUCER BILIARY STENT 8.5FR 205CML
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
900100316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.32
|
| Rate for Payer: Blue Shield of California Commercial |
$177.19
|
| Rate for Payer: Blue Shield of California EPN |
$115.71
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$185.60
|
| Rate for Payer: Cigna of CA PPO |
$214.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC KIT INTRODUCER BILIARY STENT 8.5FR 205CML
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
900100316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
|
|
HC KIT INTRODUCER SHEATH 8.5FR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698228
|
|
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 |
$192.50
|
| 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
|
|
