|
HC KIT INDR 3.5FR .018IN X 40CM
|
Facility
|
OP
|
$283.15
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.29
|
| Rate for Payer: Blue Distinction Transplant |
$169.89
|
| Rate for Payer: Blue Shield of California Commercial |
$178.10
|
| Rate for Payer: Blue Shield of California EPN |
$138.46
|
| Rate for Payer: Cash Price |
$127.42
|
| Rate for Payer: Cash Price |
$127.42
|
| Rate for Payer: Central Health Plan Commercial |
$226.52
|
| Rate for Payer: Cigna of CA HMO |
$181.22
|
| Rate for Payer: Cigna of CA PPO |
$209.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.68
|
| Rate for Payer: Dignity Health Media |
$240.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.26
|
| Rate for Payer: Galaxy Health WC |
$240.68
|
| Rate for Payer: Global Benefits Group Commercial |
$169.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$254.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$212.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.63
|
| Rate for Payer: Multiplan Commercial |
$212.36
|
| Rate for Payer: Networks By Design Commercial |
$184.05
|
| Rate for Payer: Prime Health Services Commercial |
$240.68
|
| Rate for Payer: Riverside University Health System MISP |
$113.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.58
|
| Rate for Payer: United Healthcare All Other HMO |
$141.58
|
| Rate for Payer: United Healthcare HMO Rider |
$141.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.68
|
| Rate for Payer: Vantage Medical Group Senior |
$240.68
|
|
|
HC KIT INDR 3.5FR .018IN X 40CM
|
Facility
|
IP
|
$283.15
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Cash Price |
$127.42
|
| Rate for Payer: Central Health Plan Commercial |
$226.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.26
|
| Rate for Payer: Galaxy Health WC |
$240.68
|
| Rate for Payer: Global Benefits Group Commercial |
$169.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$254.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.63
|
| Rate for Payer: Multiplan Commercial |
$212.36
|
| Rate for Payer: Networks By Design Commercial |
$184.05
|
| Rate for Payer: Prime Health Services Commercial |
$240.68
|
|
|
HC KIT INDR WITH GUIDE 4FR .018IN DIA X 40CM
|
Facility
|
IP
|
$283.15
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Cash Price |
$127.42
|
| Rate for Payer: Central Health Plan Commercial |
$226.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.26
|
| Rate for Payer: Galaxy Health WC |
$240.68
|
| Rate for Payer: Global Benefits Group Commercial |
$169.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$254.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.63
|
| Rate for Payer: Multiplan Commercial |
$212.36
|
| Rate for Payer: Networks By Design Commercial |
$184.05
|
| Rate for Payer: Prime Health Services Commercial |
$240.68
|
|
|
HC KIT INDR WITH GUIDE 4FR .018IN DIA X 40CM
|
Facility
|
OP
|
$283.15
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.29
|
| Rate for Payer: Blue Distinction Transplant |
$169.89
|
| Rate for Payer: Blue Shield of California Commercial |
$178.10
|
| Rate for Payer: Blue Shield of California EPN |
$138.46
|
| Rate for Payer: Cash Price |
$127.42
|
| Rate for Payer: Cash Price |
$127.42
|
| Rate for Payer: Central Health Plan Commercial |
$226.52
|
| Rate for Payer: Cigna of CA HMO |
$181.22
|
| Rate for Payer: Cigna of CA PPO |
$209.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.68
|
| Rate for Payer: Dignity Health Media |
$240.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.26
|
| Rate for Payer: Galaxy Health WC |
$240.68
|
| Rate for Payer: Global Benefits Group Commercial |
$169.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$254.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$212.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.63
|
| Rate for Payer: Multiplan Commercial |
$212.36
|
| Rate for Payer: Networks By Design Commercial |
$184.05
|
| Rate for Payer: Prime Health Services Commercial |
$240.68
|
| Rate for Payer: Riverside University Health System MISP |
$113.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.58
|
| Rate for Payer: United Healthcare All Other HMO |
$141.58
|
| Rate for Payer: United Healthcare HMO Rider |
$141.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.68
|
| Rate for Payer: Vantage Medical Group Senior |
$240.68
|
|
|
HC KIT INDR WITH GUIDE 5FR .018IN DIA X 40CM
|
Facility
|
IP
|
$283.15
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Cash Price |
$127.42
|
| Rate for Payer: Central Health Plan Commercial |
$226.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.26
|
| Rate for Payer: Galaxy Health WC |
$240.68
|
| Rate for Payer: Global Benefits Group Commercial |
$169.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$254.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.63
|
| Rate for Payer: Multiplan Commercial |
$212.36
|
| Rate for Payer: Networks By Design Commercial |
$184.05
|
| Rate for Payer: Prime Health Services Commercial |
$240.68
|
|
|
HC KIT INDR WITH GUIDE 5FR .018IN DIA X 40CM
|
Facility
|
OP
|
$283.15
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.29
|
| Rate for Payer: Blue Distinction Transplant |
$169.89
|
| Rate for Payer: Blue Shield of California Commercial |
$178.10
|
| Rate for Payer: Blue Shield of California EPN |
$138.46
|
| Rate for Payer: Cash Price |
$127.42
|
| Rate for Payer: Cash Price |
$127.42
|
| Rate for Payer: Central Health Plan Commercial |
$226.52
|
| Rate for Payer: Cigna of CA HMO |
$181.22
|
| Rate for Payer: Cigna of CA PPO |
$209.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.68
|
| Rate for Payer: Dignity Health Media |
$240.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.26
|
| Rate for Payer: Galaxy Health WC |
$240.68
|
| Rate for Payer: Global Benefits Group Commercial |
$169.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$254.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$212.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.63
|
| Rate for Payer: Multiplan Commercial |
$212.36
|
| Rate for Payer: Networks By Design Commercial |
$184.05
|
| Rate for Payer: Prime Health Services Commercial |
$240.68
|
| Rate for Payer: Riverside University Health System MISP |
$113.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.58
|
| Rate for Payer: United Healthcare All Other HMO |
$141.58
|
| Rate for Payer: United Healthcare HMO Rider |
$141.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.68
|
| Rate for Payer: Vantage Medical Group Senior |
$240.68
|
|
|
HC KIT INTRODUCER SHEATH 8.5FR
|
Facility
|
IP
|
$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: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC 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: Aetna of CA HMO/PPO |
$235.49
|
| 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 |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| 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: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| 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 Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC KIT PORT DRSNG CHG
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901698218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC KIT PORT DRSNG CHG
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901698218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.80
|
| Rate for Payer: Blue Distinction Transplant |
$91.20
|
| Rate for Payer: Blue Shield of California Commercial |
$95.61
|
| Rate for Payer: Blue Shield of California EPN |
$74.33
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Media |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC KIT RESUSCITATION MURRIETA
|
Facility
|
OP
|
$255.64
|
|
| Hospital Charge Code |
901698319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$230.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.03
|
| Rate for Payer: Blue Distinction Transplant |
$153.38
|
| Rate for Payer: Blue Shield of California Commercial |
$160.80
|
| Rate for Payer: Blue Shield of California EPN |
$125.01
|
| Rate for Payer: Cash Price |
$115.04
|
| Rate for Payer: Central Health Plan Commercial |
$204.51
|
| Rate for Payer: Cigna of CA HMO |
$163.61
|
| Rate for Payer: Cigna of CA PPO |
$189.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.29
|
| Rate for Payer: Dignity Health Media |
$217.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.26
|
| Rate for Payer: Galaxy Health WC |
$217.29
|
| Rate for Payer: Global Benefits Group Commercial |
$153.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$191.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.13
|
| Rate for Payer: Multiplan Commercial |
$191.73
|
| Rate for Payer: Networks By Design Commercial |
$166.17
|
| Rate for Payer: Prime Health Services Commercial |
$217.29
|
| Rate for Payer: Riverside University Health System MISP |
$102.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.82
|
| Rate for Payer: United Healthcare All Other HMO |
$127.82
|
| Rate for Payer: United Healthcare HMO Rider |
$127.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.29
|
| Rate for Payer: Vantage Medical Group Senior |
$217.29
|
|
|
HC KIT RESUSCITATION MURRIETA
|
Facility
|
IP
|
$255.64
|
|
| Hospital Charge Code |
901698319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$230.08 |
| Rate for Payer: Cash Price |
$115.04
|
| Rate for Payer: Central Health Plan Commercial |
$204.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.26
|
| Rate for Payer: Galaxy Health WC |
$217.29
|
| Rate for Payer: Global Benefits Group Commercial |
$153.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.13
|
| Rate for Payer: Multiplan Commercial |
$191.73
|
| Rate for Payer: Networks By Design Commercial |
$166.17
|
| Rate for Payer: Prime Health Services Commercial |
$217.29
|
|
|
HC KIT SPECI CATH FEMALE 8FR PVP
|
Facility
|
OP
|
$12.79
|
|
| Hospital Charge Code |
901607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.56
|
| Rate for Payer: Blue Distinction Transplant |
$7.67
|
| Rate for Payer: Blue Shield of California Commercial |
$8.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.25
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$10.23
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$9.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.87
|
| Rate for Payer: Dignity Health Media |
$10.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$10.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$9.59
|
| Rate for Payer: Networks By Design Commercial |
$8.31
|
| Rate for Payer: Prime Health Services Commercial |
$10.87
|
| Rate for Payer: Riverside University Health System MISP |
$5.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.40
|
| Rate for Payer: United Healthcare All Other HMO |
$6.40
|
| Rate for Payer: United Healthcare HMO Rider |
$6.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.87
|
| Rate for Payer: Vantage Medical Group Senior |
$10.87
|
|
|
HC KIT SPECI CATH FEMALE 8FR PVP
|
Facility
|
IP
|
$12.79
|
|
| Hospital Charge Code |
901607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$10.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$9.59
|
| Rate for Payer: Networks By Design Commercial |
$8.31
|
| Rate for Payer: Prime Health Services Commercial |
$10.87
|
|
|
HC KIT TUBE PEG 20FR
|
Facility
|
OP
|
$528.00
|
|
| Hospital Charge Code |
900831709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$320.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$448.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$255.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.94
|
| Rate for Payer: Blue Distinction Transplant |
$316.80
|
| Rate for Payer: Blue Shield of California Commercial |
$332.11
|
| Rate for Payer: Blue Shield of California EPN |
$258.19
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: Cigna of CA HMO |
$337.92
|
| Rate for Payer: Cigna of CA PPO |
$390.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$448.80
|
| Rate for Payer: Dignity Health Media |
$448.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$448.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$211.20
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$396.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$184.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
| Rate for Payer: Riverside University Health System MISP |
$211.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Other HMO |
$264.00
|
| Rate for Payer: United Healthcare HMO Rider |
$264.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$448.80
|
| Rate for Payer: Vantage Medical Group Senior |
$448.80
|
|
|
HC KIT TUBE PEG 20FR
|
Facility
|
IP
|
$528.00
|
|
| Hospital Charge Code |
900831709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.20
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
|
|
HC KIT TUBE PEG 24FR
|
Facility
|
IP
|
$528.00
|
|
| Hospital Charge Code |
900831710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.20
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
|
|
HC KIT TUBE PEG 24FR
|
Facility
|
OP
|
$528.00
|
|
| Hospital Charge Code |
900831710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$320.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$448.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$255.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.94
|
| Rate for Payer: Blue Distinction Transplant |
$316.80
|
| Rate for Payer: Blue Shield of California Commercial |
$332.11
|
| Rate for Payer: Blue Shield of California EPN |
$258.19
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: Cigna of CA HMO |
$337.92
|
| Rate for Payer: Cigna of CA PPO |
$390.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$448.80
|
| Rate for Payer: Dignity Health Media |
$448.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$448.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$211.20
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$396.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$184.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
| Rate for Payer: Riverside University Health System MISP |
$211.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Other HMO |
$264.00
|
| Rate for Payer: United Healthcare HMO Rider |
$264.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$448.80
|
| Rate for Payer: Vantage Medical Group Senior |
$448.80
|
|
|
HC KIT URINEMETER 200ML
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901603336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC KIT URINEMETER 200ML
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901603336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC KNEE 1-2 VIEWS
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.50
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$491.31
|
| Rate for Payer: Blue Shield of California EPN |
$386.37
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA HMO |
$508.80
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC KNEE 1-2 VIEWS
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.20
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.75
|
| Rate for Payer: Blue Distinction Transplant |
$547.80
|
| Rate for Payer: Blue Shield of California Commercial |
$564.23
|
| Rate for Payer: Blue Shield of California EPN |
$443.72
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: Cigna of CA HMO |
$584.32
|
| Rate for Payer: Cigna of CA PPO |
$675.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$684.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$547.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$547.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
|
