|
HC MICROALBUMIN URINE 24 HOURS
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC MICROALBUMIN URINE RANDOM
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.38
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$5.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: InnovAge PACE Commercial |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROALBUMIN URINE RANDOM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC MICROCATH DIREXION
|
Facility
|
OP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$2,750.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,680.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,479.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,805.48
|
| Rate for Payer: Blue Distinction Transplant |
$1,833.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,922.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,494.38
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,444.80
|
| Rate for Payer: Cigna of CA HMO |
$1,955.84
|
| Rate for Payer: Cigna of CA PPO |
$2,261.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Dignity Health Media |
$2,597.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,597.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,222.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,222.40
|
| Rate for Payer: Galaxy Health WC |
$2,597.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,833.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,750.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,292.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,069.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,038.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.20
|
| Rate for Payer: Multiplan Commercial |
$2,292.00
|
| Rate for Payer: Networks By Design Commercial |
$1,986.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,597.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,222.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,833.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,833.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,528.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,528.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,528.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,528.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,597.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,597.60
|
|
|
HC MICROCATH DIREXION
|
Facility
|
IP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.20 |
| Max. Negotiated Rate |
$2,750.40 |
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,444.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,222.40
|
| Rate for Payer: Galaxy Health WC |
$2,597.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,833.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,750.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,038.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.20
|
| Rate for Payer: Multiplan Commercial |
$2,292.00
|
| Rate for Payer: Networks By Design Commercial |
$1,986.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,597.60
|
|
|
HC MICROCATHETER
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC MICROCATHETER
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$643.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$566.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$691.24
|
| Rate for Payer: Blue Distinction Transplant |
$702.00
|
| Rate for Payer: Blue Shield of California Commercial |
$735.93
|
| Rate for Payer: Blue Shield of California EPN |
$572.13
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Media |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$877.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$409.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Riverside University Health System MISP |
$468.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$585.00
|
| Rate for Payer: United Healthcare All Other HMO |
$585.00
|
| Rate for Payer: United Healthcare HMO Rider |
$585.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$585.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC MICROCATH MAGIC
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,492.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,134.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,772.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,161.72
|
| Rate for Payer: Blue Distinction Transplant |
$2,328.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,910.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,111.26
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.80
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Media |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,910.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,358.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.20
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,552.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,940.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,940.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,940.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,940.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC MICROCATH MAGIC
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,492.90 |
| Rate for Payer: Blue Shield of California EPN |
$2,072.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.80
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.20
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,465.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,431.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1,400.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,280.73
|
|
|
HC MICROCATH MAGIC FLOW
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909091887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,492.90 |
| Rate for Payer: Blue Shield of California EPN |
$2,072.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.80
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.20
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,465.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,431.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1,400.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,280.73
|
|
|
HC MICROCATH MAGIC FLOW
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909091887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,492.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,134.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,772.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,161.72
|
| Rate for Payer: Blue Distinction Transplant |
$2,328.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,910.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,111.26
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.80
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Media |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,910.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,358.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.20
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,552.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,940.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,940.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,940.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,940.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC MICROCATH NAVIEN
|
Facility
|
OP
|
$3,563.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.60 |
| Max. Negotiated Rate |
$3,206.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,959.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,959.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,626.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,984.59
|
| Rate for Payer: Blue Distinction Transplant |
$2,137.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,672.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,938.27
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,850.40
|
| Rate for Payer: Cigna of CA HMO |
$2,494.10
|
| Rate for Payer: Cigna of CA PPO |
$2,494.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Dignity Health Media |
$3,028.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,028.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,425.20
|
| Rate for Payer: Galaxy Health WC |
$3,028.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,206.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,672.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,247.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,376.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.60
|
| Rate for Payer: Multiplan Commercial |
$2,672.25
|
| Rate for Payer: Networks By Design Commercial |
$1,781.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,028.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,425.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,137.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,137.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,028.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,028.55
|
|
|
HC MICROCATH NAVIEN
|
Facility
|
IP
|
$3,563.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.60 |
| Max. Negotiated Rate |
$3,206.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,902.64
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,850.40
|
| Rate for Payer: Cigna of CA HMO |
$2,494.10
|
| Rate for Payer: Cigna of CA PPO |
$2,494.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,425.20
|
| Rate for Payer: Galaxy Health WC |
$3,028.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,206.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,376.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.60
|
| Rate for Payer: Multiplan Commercial |
$2,672.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,028.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,345.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,314.03
|
| Rate for Payer: United Healthcare HMO Rider |
$1,285.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,175.79
|
|
|
HC MICROCATH ORION
|
Facility
|
OP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$4,190.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,560.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,560.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,254.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,750.76
|
| Rate for Payer: Blue Distinction Transplant |
$2,793.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,928.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,276.78
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,724.80
|
| Rate for Payer: Cigna of CA HMO |
$2,979.84
|
| Rate for Payer: Cigna of CA PPO |
$3,445.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Dignity Health Media |
$3,957.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,862.40
|
| Rate for Payer: Galaxy Health WC |
$3,957.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,793.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,190.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,492.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,629.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,105.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,773.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.20
|
| Rate for Payer: Multiplan Commercial |
$3,492.00
|
| Rate for Payer: Networks By Design Commercial |
$3,026.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,957.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,862.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,793.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,793.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,328.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,957.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,957.60
|
|
|
HC MICROCATH ORION
|
Facility
|
IP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.20 |
| Max. Negotiated Rate |
$4,190.40 |
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,724.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.40
|
| Rate for Payer: Galaxy Health WC |
$3,957.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,793.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,190.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,105.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,773.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.20
|
| Rate for Payer: Multiplan Commercial |
$3,492.00
|
| Rate for Payer: Networks By Design Commercial |
$3,026.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,957.60
|
|
|
HC MICRO CATH, PENUMBRA
|
Facility
|
OP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$3,264.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,994.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,994.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,756.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,142.83
|
| Rate for Payer: Blue Distinction Transplant |
$2,176.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,281.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,773.60
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,901.60
|
| Rate for Payer: Cigna of CA HMO |
$2,321.28
|
| Rate for Payer: Cigna of CA PPO |
$2,683.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Dignity Health Media |
$3,082.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,082.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,450.80
|
| Rate for Payer: Galaxy Health WC |
$3,082.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,264.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,720.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,269.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.40
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
| Rate for Payer: Networks By Design Commercial |
$2,357.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,450.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,176.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,813.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,813.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,813.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,082.95
|
|
|
HC MICRO CATH, PENUMBRA
|
Facility
|
IP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$3,264.30 |
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,901.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.80
|
| Rate for Payer: Galaxy Health WC |
$3,082.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,264.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.40
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
| Rate for Payer: Networks By Design Commercial |
$2,357.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.95
|
|
|
HC MICROCATH PHENOM 17
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,664.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Networks By Design Commercial |
$1,924.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
|
|
HC MICROCATH PHENOM 17
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,628.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,628.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,433.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,748.77
|
| Rate for Payer: Blue Distinction Transplant |
$1,776.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,861.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,447.44
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| Rate for Payer: Cigna of CA HMO |
$1,894.40
|
| Rate for Payer: Cigna of CA PPO |
$2,190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Dignity Health Media |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,664.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,220.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,036.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Networks By Design Commercial |
$1,924.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,184.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,776.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,776.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,480.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,480.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,480.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
HC MICROCATH SOFIA HEADWAY
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909041887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Blue Shield of California EPN |
$2,603.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,840.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1,797.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,758.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.75
|
|
|
HC MICROCATH SOFIA HEADWAY
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909041887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,681.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,225.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,715.38
|
| Rate for Payer: Blue Distinction Transplant |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,656.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,652.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Media |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,656.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,706.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,950.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC MICROCATH SWIFT NINJA
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909011887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,681.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,225.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,715.38
|
| Rate for Payer: Blue Distinction Transplant |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,656.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,652.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Media |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,656.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,706.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,950.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC MICROCATH SWIFT NINJA
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909011887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Blue Shield of California EPN |
$2,603.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,840.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1,797.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,758.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.75
|
|
|
HC MICROCATH TREVO PRO
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,545.20 |
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,545.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: Networks By Design Commercial |
$1,838.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
|
|
HC MICROCATH TREVO PRO
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$2,545.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,555.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,369.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,670.78
|
| Rate for Payer: Blue Distinction Transplant |
$1,696.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,778.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.89
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,262.40
|
| Rate for Payer: Cigna of CA HMO |
$1,809.92
|
| Rate for Payer: Cigna of CA PPO |
$2,092.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Dignity Health Media |
$2,403.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,545.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,121.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$989.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: Networks By Design Commercial |
$1,838.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,131.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,414.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
