|
HC KIT CATH HEMO NGRA 12FR 15CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Blue Shield of California EPN |
$309.72
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.01
|
| Rate for Payer: United Healthcare All Other HMO |
$213.90
|
| Rate for Payer: United Healthcare HMO Rider |
$209.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
|
|
HC KIT CATH HEMO NGRA 12FR 15CM
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.06
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$435.00
|
| Rate for Payer: Blue Shield of California EPN |
$315.52
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC KIT CATH HEMO NGRA DL 12FR20C
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.06
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$435.00
|
| Rate for Payer: Blue Shield of California EPN |
$315.52
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC KIT CATH HEMO NGRA DL 12FR20C
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Blue Shield of California EPN |
$309.72
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.01
|
| Rate for Payer: United Healthcare All Other HMO |
$213.90
|
| Rate for Payer: United Healthcare HMO Rider |
$209.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
|
|
HC KIT CATH HEMO NGRA DL 12FR24C
|
Facility
|
IP
|
$901.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$811.44 |
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Central Health Plan Commercial |
$721.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.64
|
| Rate for Payer: Galaxy Health WC |
$766.36
|
| Rate for Payer: Global Benefits Group Commercial |
$540.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$601.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$676.20
|
| Rate for Payer: Networks By Design Commercial |
$586.04
|
| Rate for Payer: Prime Health Services Commercial |
$766.36
|
|
|
HC KIT CATH HEMO NGRA DL 12FR24C
|
Facility
|
OP
|
$901.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901605111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$2,180.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,180.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$766.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$436.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.67
|
| Rate for Payer: Blue Distinction Transplant |
$540.96
|
| Rate for Payer: Blue Shield of California Commercial |
$567.11
|
| Rate for Payer: Blue Shield of California EPN |
$440.88
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Central Health Plan Commercial |
$721.28
|
| Rate for Payer: Cigna of CA HMO |
$577.02
|
| Rate for Payer: Cigna of CA PPO |
$667.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$766.36
|
| Rate for Payer: Dignity Health Media |
$766.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.64
|
| Rate for Payer: Galaxy Health WC |
$766.36
|
| Rate for Payer: Global Benefits Group Commercial |
$540.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$676.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$601.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$676.20
|
| Rate for Payer: Networks By Design Commercial |
$586.04
|
| Rate for Payer: Prime Health Services Commercial |
$766.36
|
| Rate for Payer: Riverside University Health System MISP |
$360.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.80
|
| Rate for Payer: United Healthcare All Other HMO |
$450.80
|
| Rate for Payer: United Healthcare HMO Rider |
$450.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.36
|
| Rate for Payer: Vantage Medical Group Senior |
$766.36
|
|
|
HC KIT CATH HICKMAN RPR 10FR
|
Facility
|
OP
|
$1,320.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.04 |
| Max. Negotiated Rate |
$1,188.18 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,122.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$726.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$726.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$602.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$735.35
|
| Rate for Payer: Blue Distinction Transplant |
$792.12
|
| Rate for Payer: Blue Shield of California Commercial |
$990.15
|
| Rate for Payer: Blue Shield of California EPN |
$718.19
|
| Rate for Payer: Cash Price |
$594.09
|
| Rate for Payer: Central Health Plan Commercial |
$1,056.16
|
| Rate for Payer: Cigna of CA HMO |
$924.14
|
| Rate for Payer: Cigna of CA PPO |
$924.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,122.17
|
| Rate for Payer: Dignity Health Media |
$1,122.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,122.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$528.08
|
| Rate for Payer: Galaxy Health WC |
$1,122.17
|
| Rate for Payer: Global Benefits Group Commercial |
$792.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,188.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$990.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$462.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$880.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.04
|
| Rate for Payer: Multiplan Commercial |
$990.15
|
| Rate for Payer: Networks By Design Commercial |
$660.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.17
|
| Rate for Payer: Riverside University Health System MISP |
$528.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$792.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$792.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.10
|
| Rate for Payer: United Healthcare All Other HMO |
$660.10
|
| Rate for Payer: United Healthcare HMO Rider |
$660.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$660.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,122.17
|
| Rate for Payer: Vantage Medical Group Senior |
$1,122.17
|
|
|
HC KIT CATH HICKMAN RPR 10FR
|
Facility
|
IP
|
$1,320.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.04 |
| Max. Negotiated Rate |
$1,188.18 |
| Rate for Payer: Blue Shield of California EPN |
$704.99
|
| Rate for Payer: Cash Price |
$594.09
|
| Rate for Payer: Central Health Plan Commercial |
$1,056.16
|
| Rate for Payer: Cigna of CA HMO |
$924.14
|
| Rate for Payer: Cigna of CA PPO |
$924.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$528.08
|
| Rate for Payer: Galaxy Health WC |
$1,122.17
|
| Rate for Payer: Global Benefits Group Commercial |
$792.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,188.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$880.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.04
|
| Rate for Payer: Multiplan Commercial |
$990.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$498.51
|
| Rate for Payer: United Healthcare All Other HMO |
$486.89
|
| Rate for Payer: United Healthcare HMO Rider |
$476.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$435.67
|
|
|
HC KIT CATH HICKMAN RPR 12FR
|
Facility
|
OP
|
$961.40
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.28 |
| Max. Negotiated Rate |
$865.26 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$817.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$528.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$438.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$535.50
|
| Rate for Payer: Blue Distinction Transplant |
$576.84
|
| Rate for Payer: Blue Shield of California Commercial |
$721.05
|
| Rate for Payer: Blue Shield of California EPN |
$523.00
|
| Rate for Payer: Cash Price |
$432.63
|
| Rate for Payer: Central Health Plan Commercial |
$769.12
|
| Rate for Payer: Cigna of CA HMO |
$672.98
|
| Rate for Payer: Cigna of CA PPO |
$672.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$817.19
|
| Rate for Payer: Dignity Health Media |
$817.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$817.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$384.56
|
| Rate for Payer: Galaxy Health WC |
$817.19
|
| Rate for Payer: Global Benefits Group Commercial |
$576.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$865.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$721.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$641.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.28
|
| Rate for Payer: Multiplan Commercial |
$721.05
|
| Rate for Payer: Networks By Design Commercial |
$480.70
|
| Rate for Payer: Prime Health Services Commercial |
$817.19
|
| Rate for Payer: Riverside University Health System MISP |
$384.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$576.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$480.70
|
| Rate for Payer: United Healthcare All Other HMO |
$480.70
|
| Rate for Payer: United Healthcare HMO Rider |
$480.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$817.19
|
| Rate for Payer: Vantage Medical Group Senior |
$817.19
|
|
|
HC KIT CATH HICKMAN RPR 12FR
|
Facility
|
IP
|
$961.40
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.28 |
| Max. Negotiated Rate |
$865.26 |
| Rate for Payer: Blue Shield of California EPN |
$513.39
|
| Rate for Payer: Cash Price |
$432.63
|
| Rate for Payer: Central Health Plan Commercial |
$769.12
|
| Rate for Payer: Cigna of CA HMO |
$672.98
|
| Rate for Payer: Cigna of CA PPO |
$672.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$384.56
|
| Rate for Payer: Galaxy Health WC |
$817.19
|
| Rate for Payer: Global Benefits Group Commercial |
$576.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$865.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$641.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.28
|
| Rate for Payer: Multiplan Commercial |
$721.05
|
| Rate for Payer: Prime Health Services Commercial |
$817.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$363.02
|
| Rate for Payer: United Healthcare All Other HMO |
$354.56
|
| Rate for Payer: United Healthcare HMO Rider |
$346.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$317.26
|
|
|
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: 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 |
$221.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.08
|
| Rate for Payer: Blue Distinction Transplant |
$241.37
|
| Rate for Payer: Blue Shield of California Commercial |
$301.72
|
| Rate for Payer: Blue Shield of California EPN |
$218.85
|
| Rate for Payer: Cash Price |
$181.03
|
| 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 Media |
$341.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$301.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.80
|
| 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: LLUH Dept of Risk Management WC |
$80.46
|
| Rate for Payer: Multiplan Commercial |
$301.72
|
| Rate for Payer: Networks By Design Commercial |
$201.14
|
| 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 |
$201.14
|
| Rate for Payer: United Healthcare All Other HMO |
$201.14
|
| Rate for Payer: United Healthcare HMO Rider |
$201.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.95
|
| Rate for Payer: Vantage Medical Group Senior |
$341.95
|
|
|
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: Blue Shield of California EPN |
$214.82
|
| Rate for Payer: Cash Price |
$181.03
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$80.46
|
| Rate for Payer: Multiplan Commercial |
$301.72
|
| Rate for Payer: Prime Health Services Commercial |
$341.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.90
|
| Rate for Payer: United Healthcare All Other HMO |
$148.36
|
| Rate for Payer: United Healthcare HMO Rider |
$145.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.76
|
|
|
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: 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 |
$1,265.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,358.84
|
| Rate for Payer: Blue Distinction Transplant |
$1,380.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,124.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| 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 Media |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,725.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$805.00
|
| 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: 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
|
| 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 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: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
$2,784.87
|
|
| Hospital Charge Code |
901695702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$556.97 |
| Max. Negotiated Rate |
$2,506.38 |
| Rate for Payer: Cash Price |
$1,253.19
|
| Rate for Payer: Central Health Plan Commercial |
$2,227.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,113.95
|
| Rate for Payer: Galaxy Health WC |
$2,367.14
|
| Rate for Payer: Global Benefits Group Commercial |
$1,670.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,506.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,857.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.97
|
| Rate for Payer: Multiplan Commercial |
$2,088.65
|
| Rate for Payer: Networks By Design Commercial |
$1,810.17
|
| Rate for Payer: Prime Health Services Commercial |
$2,367.14
|
|
|
HC KIT CATH ICP 4FR LICOX+IT2
|
Facility
|
OP
|
$2,784.87
|
|
| Hospital Charge Code |
901695702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$556.97 |
| Max. Negotiated Rate |
$2,506.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,691.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,367.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,531.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,531.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,348.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,645.30
|
| Rate for Payer: Blue Distinction Transplant |
$1,670.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,751.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,361.80
|
| Rate for Payer: Cash Price |
$1,253.19
|
| Rate for Payer: Central Health Plan Commercial |
$2,227.90
|
| Rate for Payer: Cigna of CA HMO |
$1,782.32
|
| Rate for Payer: Cigna of CA PPO |
$2,060.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,367.14
|
| Rate for Payer: Dignity Health Media |
$2,367.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,367.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,113.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,113.95
|
| Rate for Payer: Galaxy Health WC |
$2,367.14
|
| Rate for Payer: Global Benefits Group Commercial |
$1,670.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,506.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,088.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$974.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,857.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.97
|
| Rate for Payer: Multiplan Commercial |
$2,088.65
|
| Rate for Payer: Networks By Design Commercial |
$1,810.17
|
| Rate for Payer: Prime Health Services Commercial |
$2,367.14
|
| Rate for Payer: Riverside University Health System MISP |
$1,113.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,670.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,670.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,392.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,392.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,392.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,392.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,367.14
|
| Rate for Payer: Vantage Medical Group Senior |
$2,367.14
|
|
|
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: Cash Price |
$1,174.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,088.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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: 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 |
$1,435.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,263.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,541.99
|
| Rate for Payer: Blue Distinction Transplant |
$1,566.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,276.29
|
| Rate for Payer: Cash Price |
$1,174.50
|
| 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 Media |
$2,218.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,957.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$913.50
|
| 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: 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
|
| 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 Medi-Cal |
$2,218.50
|
| Rate for Payer: Vantage Medical Group Senior |
$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: Cash Price |
$1,518.08
|
| Rate for Payer: Central Health Plan Commercial |
$2,698.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,349.40
|
| Rate for Payer: Galaxy Health WC |
$2,867.48
|
| 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: 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 |
$2,867.48
|
|
|
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: Aetna of CA HMO/PPO |
$2,048.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,867.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,855.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,855.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,633.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,993.06
|
| Rate for Payer: Blue Distinction Transplant |
$2,024.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,121.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,649.64
|
| Rate for Payer: Cash Price |
$1,518.08
|
| 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 |
$2,867.48
|
| Rate for Payer: Dignity Health Media |
$2,867.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,867.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,349.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,349.40
|
| Rate for Payer: Galaxy Health WC |
$2,867.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2,024.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,036.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,530.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,180.72
|
| 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: 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 |
$2,867.48
|
| 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 Medi-Cal |
$2,867.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2,867.48
|
|
|
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: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: 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: 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: 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 |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| 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: 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
|
| 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 Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$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: 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 |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| 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: 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
|
| 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 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: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: 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: 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 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: Blue Shield of California EPN |
$309.72
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.01
|
| Rate for Payer: United Healthcare All Other HMO |
$213.90
|
| Rate for Payer: United Healthcare HMO Rider |
$209.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
|
