|
HC TRANSDUCER PED A-LINE CVP
|
Facility
|
OP
|
$242.20
|
|
| Hospital Charge Code |
901604261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.44 |
| Max. Negotiated Rate |
$205.87 |
| Rate for Payer: Adventist Health Commercial |
$48.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.74
|
| Rate for Payer: Cash Price |
$133.21
|
| Rate for Payer: Cigna of CA HMO |
$155.01
|
| Rate for Payer: Cigna of CA PPO |
$179.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.88
|
| Rate for Payer: EPIC Health Plan Senior |
$96.88
|
| Rate for Payer: Galaxy Health WC |
$205.87
|
| Rate for Payer: Global Benefits Group Commercial |
$145.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$169.54
|
| Rate for Payer: Multiplan Commercial |
$193.76
|
| Rate for Payer: Networks By Design Commercial |
$157.43
|
| Rate for Payer: Prime Health Services Commercial |
$205.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.10
|
| Rate for Payer: United Healthcare All Other HMO |
$121.10
|
| Rate for Payer: United Healthcare HMO Rider |
$121.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.87
|
| Rate for Payer: Vantage Medical Group Senior |
$205.87
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$406.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.74
|
| Rate for Payer: Blue Shield of California Commercial |
$379.44
|
| Rate for Payer: Blue Shield of California EPN |
$250.48
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna of CA HMO |
$396.80
|
| Rate for Payer: Cigna of CA PPO |
$458.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$248.00
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$203.15 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.80
|
| Rate for Payer: Blue Shield of California Commercial |
$159.89
|
| Rate for Payer: Blue Shield of California EPN |
$105.64
|
| Rate for Payer: Cash Price |
$131.45
|
| Rate for Payer: Cash Price |
$131.45
|
| Rate for Payer: Cigna of CA HMO |
$152.96
|
| Rate for Payer: Cigna of CA PPO |
$176.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.23
|
| Rate for Payer: EPIC Health Plan Senior |
$12.76
|
| Rate for Payer: Galaxy Health WC |
$203.15
|
| Rate for Payer: Global Benefits Group Commercial |
$143.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$191.20
|
| Rate for Payer: Networks By Design Commercial |
$155.35
|
| Rate for Payer: Prime Health Services Commercial |
$203.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$203.15 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Cash Price |
$131.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.60
|
| Rate for Payer: EPIC Health Plan Senior |
$95.60
|
| Rate for Payer: Galaxy Health WC |
$203.15
|
| Rate for Payer: Global Benefits Group Commercial |
$143.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.36
|
| Rate for Payer: Multiplan Commercial |
$191.20
|
| Rate for Payer: Networks By Design Commercial |
$155.35
|
| Rate for Payer: Prime Health Services Commercial |
$203.15
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: Cigna of CA HMO |
$1,603.84
|
| Rate for Payer: Cigna of CA PPO |
$1,854.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,671.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,503.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,253.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$2,130.10 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,002.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,671.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,551.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: Cigna of CA HMO |
$1,603.84
|
| Rate for Payer: Cigna of CA PPO |
$1,854.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,671.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,503.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,503.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$2,130.10 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,002.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,671.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,551.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
940100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$2,130.10 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,002.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,671.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,551.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
940100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: Cash Price |
$1,378.30
|
| Rate for Payer: Cigna of CA HMO |
$1,603.84
|
| Rate for Payer: Cigna of CA PPO |
$1,854.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,671.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,503.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,503.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$1,265.65 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.60
|
| Rate for Payer: EPIC Health Plan Senior |
$595.60
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$993.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.36
|
| Rate for Payer: Multiplan Commercial |
$1,191.20
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cigna of CA HMO |
$952.96
|
| Rate for Payer: Cigna of CA PPO |
$1,101.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$520.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$993.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$1,191.20
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$893.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$893.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: Cigna of CA HMO |
$952.96
|
| Rate for Payer: Cigna of CA PPO |
$1,101.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$520.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$993.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$1,191.20
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$893.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$893.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$1,265.65 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Cash Price |
$818.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.60
|
| Rate for Payer: EPIC Health Plan Senior |
$595.60
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$993.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.36
|
| Rate for Payer: Multiplan Commercial |
$1,191.20
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$52.18
|
| Rate for Payer: Blue Shield of California EPN |
$34.48
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TRANSTHYRETIN
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
|
HC TRANSTHYRETIN
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.50
|
| Rate for Payer: Blue Shield of California Commercial |
$245.52
|
| Rate for Payer: Blue Shield of California EPN |
$162.21
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cigna of CA HMO |
$234.88
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.70
|
| Rate for Payer: EPIC Health Plan Senior |
$14.59
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.55
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO |
$11.82
|
| Rate for Payer: United Healthcare HMO Rider |
$11.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14.59
|
|
|
HC TRAUMA ACTIVATION LEVEL A
|
Facility
|
IP
|
$75,036.00
|
|
| Hospital Charge Code |
904300100
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$13,617.00 |
| Max. Negotiated Rate |
$63,780.60 |
| Rate for Payer: Adventist Health Commercial |
$15,007.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,617.00
|
| Rate for Payer: Cash Price |
$41,269.80
|
| Rate for Payer: Cash Price |
$41,269.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,014.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30,014.40
|
| Rate for Payer: Galaxy Health WC |
$63,780.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45,021.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50,049.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,588.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,447.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,008.64
|
| Rate for Payer: Multiplan Commercial |
$60,028.80
|
| Rate for Payer: Prime Health Services Commercial |
$63,780.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$36,797.65
|
| Rate for Payer: United Healthcare All Other HMO |
$33,826.23
|
| Rate for Payer: United Healthcare HMO Rider |
$32,475.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29,751.77
|
|
|
HC TRAUMA ACTIVATION LEVEL A
|
Facility
|
OP
|
$75,036.00
|
|
| Hospital Charge Code |
904300100
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$10,570.00 |
| Max. Negotiated Rate |
$63,780.60 |
| Rate for Payer: Adventist Health Commercial |
$15,007.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57,267.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63,780.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41,269.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56,277.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,570.00
|
| Rate for Payer: Cash Price |
$41,269.80
|
| Rate for Payer: Cash Price |
$41,269.80
|
| Rate for Payer: Cigna of CA PPO |
$55,526.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63,780.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$63,780.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63,780.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,014.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30,014.40
|
| Rate for Payer: Galaxy Health WC |
$63,780.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45,021.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50,049.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,588.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,447.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,008.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,525.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52,525.20
|
| Rate for Payer: Multiplan Commercial |
$60,028.80
|
| Rate for Payer: Networks By Design Commercial |
$63,780.60
|
| Rate for Payer: Prime Health Services Commercial |
$63,780.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45,021.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45,021.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$36,797.65
|
| Rate for Payer: United Healthcare All Other HMO |
$33,826.23
|
| Rate for Payer: United Healthcare HMO Rider |
$32,475.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29,751.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63,780.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63,780.60
|
| Rate for Payer: Vantage Medical Group Senior |
$63,780.60
|
|
|
HC TRAUMA ACTIVATION LEVEL B
|
Facility
|
OP
|
$44,636.00
|
|
| Hospital Charge Code |
904300101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$8,927.20 |
| Max. Negotiated Rate |
$37,940.60 |
| Rate for Payer: Adventist Health Commercial |
$8,927.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34,066.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,940.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,549.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33,477.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,570.00
|
| Rate for Payer: Cash Price |
$24,549.80
|
| Rate for Payer: Cash Price |
$24,549.80
|
| Rate for Payer: Cigna of CA PPO |
$33,030.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,940.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$37,940.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37,940.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,854.40
|
| Rate for Payer: EPIC Health Plan Senior |
$17,854.40
|
| Rate for Payer: Galaxy Health WC |
$37,940.60
|
| Rate for Payer: Global Benefits Group Commercial |
$26,781.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,772.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,006.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,629.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,712.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,245.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,245.20
|
| Rate for Payer: Multiplan Commercial |
$35,708.80
|
| Rate for Payer: Networks By Design Commercial |
$37,940.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,940.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,781.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26,781.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$21,889.49
|
| Rate for Payer: United Healthcare All Other HMO |
$20,121.91
|
| Rate for Payer: United Healthcare HMO Rider |
$19,318.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,698.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,940.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37,940.60
|
| Rate for Payer: Vantage Medical Group Senior |
$37,940.60
|
|
|
HC TRAUMA ACTIVATION LEVEL B
|
Facility
|
IP
|
$44,636.00
|
|
| Hospital Charge Code |
904300101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$8,927.20 |
| Max. Negotiated Rate |
$37,940.60 |
| Rate for Payer: Adventist Health Commercial |
$8,927.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,617.00
|
| Rate for Payer: Cash Price |
$24,549.80
|
| Rate for Payer: Cash Price |
$24,549.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,854.40
|
| Rate for Payer: EPIC Health Plan Senior |
$17,854.40
|
| Rate for Payer: Galaxy Health WC |
$37,940.60
|
| Rate for Payer: Global Benefits Group Commercial |
$26,781.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,772.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,006.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,629.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,712.64
|
| Rate for Payer: Multiplan Commercial |
$35,708.80
|
| Rate for Payer: Prime Health Services Commercial |
$37,940.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$21,889.49
|
| Rate for Payer: United Healthcare All Other HMO |
$20,121.91
|
| Rate for Payer: United Healthcare HMO Rider |
$19,318.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,698.17
|
|
|
HC TRAUMA ACTIVATION LEVEL C
|
Facility
|
IP
|
$19,713.00
|
|
| Hospital Charge Code |
904300102
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,942.60 |
| Max. Negotiated Rate |
$16,756.05 |
| Rate for Payer: Adventist Health Commercial |
$3,942.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,617.00
|
| Rate for Payer: Cash Price |
$10,842.15
|
| Rate for Payer: Cash Price |
$10,842.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,885.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,885.20
|
| Rate for Payer: Galaxy Health WC |
$16,756.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,827.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,148.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,510.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,202.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,731.12
|
| Rate for Payer: Multiplan Commercial |
$15,770.40
|
| Rate for Payer: Prime Health Services Commercial |
$16,756.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,667.26
|
| Rate for Payer: United Healthcare All Other HMO |
$8,886.62
|
| Rate for Payer: United Healthcare HMO Rider |
$8,531.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,816.20
|
|
|
HC TRAUMA ACTIVATION LEVEL C
|
Facility
|
OP
|
$19,713.00
|
|
| Hospital Charge Code |
904300102
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,942.60 |
| Max. Negotiated Rate |
$16,756.05 |
| Rate for Payer: Adventist Health Commercial |
$3,942.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,044.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,756.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,842.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,784.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,570.00
|
| Rate for Payer: Cash Price |
$10,842.15
|
| Rate for Payer: Cash Price |
$10,842.15
|
| Rate for Payer: Cigna of CA PPO |
$14,587.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,756.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,756.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,756.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,885.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,885.20
|
| Rate for Payer: Galaxy Health WC |
$16,756.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,827.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,148.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,510.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,202.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,731.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,799.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,799.10
|
| Rate for Payer: Multiplan Commercial |
$15,770.40
|
| Rate for Payer: Networks By Design Commercial |
$16,756.05
|
| Rate for Payer: Prime Health Services Commercial |
$16,756.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,827.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,827.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,667.26
|
| Rate for Payer: United Healthcare All Other HMO |
$8,886.62
|
| Rate for Payer: United Healthcare HMO Rider |
$8,531.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,816.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,756.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,756.05
|
| Rate for Payer: Vantage Medical Group Senior |
$16,756.05
|
|
