|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| 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 Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.47
|
| Rate for Payer: Blue Shield of California Commercial |
$35.96
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$54.37
|
| Rate for Payer: Blue Shield of California Commercial |
$37.64
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| 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 Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| 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 Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| 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 Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
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 |
$35.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$49.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.02
|
| 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 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 |
$165.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.53
|
| 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
|
$110.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14.59
|
| Rate for Payer: Vantage Medical Group Senior |
$14.59
|
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.89
|
| 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 Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.00
|
| Rate for Payer: Blue Shield of California Commercial |
$169.19
|
| Rate for Payer: Blue Shield of California Commercial |
$50.71
|
| Rate for Payer: Blue Shield of California Commercial |
$255.80
|
| Rate for Payer: Blue Shield of California Commercial |
$76.67
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$234.88
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Senior |
$16.05
|
| Rate for Payer: EPIC Health Plan Senior |
$16.05
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.95
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| 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 Medi-Cal |
$18.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.55
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| 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 Commercial |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$11.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.59
|
| 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 Commercial/Exchange |
$21.89
|
|
|
HC TRAUMA ACTIVATION LEVEL A
|
Facility
|
IP
|
$75,036.00
|
|
| Hospital Charge Code |
904300100
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$14,230.00 |
| 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 |
$14,230.00
|
| Rate for Payer: Cash Price |
$33,766.20
|
| Rate for Payer: Cash Price |
$33,766.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52,525.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$47,647.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44,271.24
|
| 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 |
$11,046.00 |
| 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 |
$11,046.00
|
| Rate for Payer: Cash Price |
$33,766.20
|
| Rate for Payer: Cash Price |
$33,766.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$52,525.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$47,647.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,238.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44,271.24
|
| 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 |
$48,773.40
|
| 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 |
$11,046.00
|
| Rate for Payer: Cash Price |
$20,086.20
|
| Rate for Payer: Cash Price |
$20,086.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$31,245.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$28,343.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,202.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,335.24
|
| 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 |
$29,013.40
|
| 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 |
$14,230.00
|
| Rate for Payer: Cash Price |
$20,086.20
|
| Rate for Payer: Cash Price |
$20,086.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31,245.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$28,343.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,335.24
|
| 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 |
$14,230.00
|
| Rate for Payer: Cash Price |
$8,870.85
|
| Rate for Payer: Cash Price |
$8,870.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,799.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12,517.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,630.67
|
| 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 |
$11,046.00
|
| Rate for Payer: Cash Price |
$8,870.85
|
| Rate for Payer: Cash Price |
$8,870.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,799.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12,517.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,155.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,630.67
|
| 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 |
$12,813.45
|
| 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
|
|
|
HC TRAUMACATH VENTRCULR SET 1.9MM
|
Facility
|
OP
|
$603.66
|
|
| Hospital Charge Code |
901698858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.73 |
| Max. Negotiated Rate |
$513.11 |
| Rate for Payer: Cigna of CA HMO |
$386.34
|
| Rate for Payer: Cigna of CA PPO |
$446.71
|
| Rate for Payer: Adventist Health Commercial |
$120.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$513.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$452.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$387.37
|
| Rate for Payer: Cash Price |
$271.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$513.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$513.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$513.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.46
|
| Rate for Payer: EPIC Health Plan Senior |
$241.46
|
| Rate for Payer: Galaxy Health WC |
$513.11
|
| Rate for Payer: Global Benefits Group Commercial |
$362.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$383.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.56
|
| Rate for Payer: Multiplan Commercial |
$482.93
|
| Rate for Payer: Networks By Design Commercial |
$392.38
|
| Rate for Payer: Prime Health Services Commercial |
$513.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$362.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$362.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$301.83
|
| Rate for Payer: United Healthcare All Other HMO |
$301.83
|
| Rate for Payer: United Healthcare HMO Rider |
$301.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$301.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$513.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$513.11
|
| Rate for Payer: Vantage Medical Group Senior |
$513.11
|
|
|
HC TRAUMACATH VENTRCULR SET 1.9MM
|
Facility
|
IP
|
$603.66
|
|
| Hospital Charge Code |
901698858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.73 |
| Max. Negotiated Rate |
$513.11 |
| Rate for Payer: Adventist Health Commercial |
$120.73
|
| Rate for Payer: Cash Price |
$271.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.46
|
| Rate for Payer: EPIC Health Plan Senior |
$241.46
|
| Rate for Payer: Galaxy Health WC |
$513.11
|
| Rate for Payer: Global Benefits Group Commercial |
$362.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$383.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.88
|
| Rate for Payer: Multiplan Commercial |
$482.93
|
| Rate for Payer: Networks By Design Commercial |
$392.38
|
| Rate for Payer: Prime Health Services Commercial |
$513.11
|
|
|
HC TRAY CATH 14FR URN MTR/DRAIN
|
Facility
|
IP
|
$99.94
|
|
| Hospital Charge Code |
901698935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$84.95 |
| Rate for Payer: Adventist Health Commercial |
$19.99
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$79.95
|
| Rate for Payer: Networks By Design Commercial |
$64.96
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
|
|
HC TRAY CATH 14FR URN MTR/DRAIN
|
Facility
|
OP
|
$99.94
|
|
| Hospital Charge Code |
901698935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$84.95 |
| Rate for Payer: Adventist Health Commercial |
$19.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.13
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cigna of CA HMO |
$63.96
|
| Rate for Payer: Cigna of CA PPO |
$73.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.96
|
| Rate for Payer: Multiplan Commercial |
$79.95
|
| Rate for Payer: Networks By Design Commercial |
$64.96
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.97
|
| Rate for Payer: United Healthcare All Other HMO |
$49.97
|
| Rate for Payer: United Healthcare HMO Rider |
$49.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.95
|
| Rate for Payer: Vantage Medical Group Senior |
$84.95
|
|
|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
|
IP
|
$162.12
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.91
|
| Rate for Payer: Multiplan Commercial |
$129.70
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
|
|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
|
OP
|
$162.12
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.03
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Cigna of CA HMO |
$103.76
|
| Rate for Payer: Cigna of CA PPO |
$119.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.48
|
| Rate for Payer: Multiplan Commercial |
$129.70
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.06
|
| Rate for Payer: United Healthcare All Other HMO |
$81.06
|
| Rate for Payer: United Healthcare HMO Rider |
$81.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.80
|
| Rate for Payer: Vantage Medical Group Senior |
$137.80
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
|
OP
|
$105.49
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$89.67 |
| Rate for Payer: Adventist Health Commercial |
$21.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.69
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cigna of CA HMO |
$67.51
|
| Rate for Payer: Cigna of CA PPO |
$78.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.20
|
| Rate for Payer: EPIC Health Plan Senior |
$42.20
|
| Rate for Payer: Galaxy Health WC |
$89.67
|
| Rate for Payer: Global Benefits Group Commercial |
$63.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.84
|
| Rate for Payer: Multiplan Commercial |
$84.39
|
| Rate for Payer: Networks By Design Commercial |
$68.57
|
| Rate for Payer: Prime Health Services Commercial |
$89.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.74
|
| Rate for Payer: United Healthcare All Other HMO |
$52.74
|
| Rate for Payer: United Healthcare HMO Rider |
$52.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.67
|
| Rate for Payer: Vantage Medical Group Senior |
$89.67
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
|
IP
|
$105.49
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$89.67 |
| Rate for Payer: Adventist Health Commercial |
$21.10
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.20
|
| Rate for Payer: EPIC Health Plan Senior |
$42.20
|
| Rate for Payer: Galaxy Health WC |
$89.67
|
| Rate for Payer: Global Benefits Group Commercial |
$63.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.32
|
| Rate for Payer: Multiplan Commercial |
$84.39
|
| Rate for Payer: Networks By Design Commercial |
$68.57
|
| Rate for Payer: Prime Health Services Commercial |
$89.67
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
|
OP
|
$125.86
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$106.98 |
| Rate for Payer: Adventist Health Commercial |
$25.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.76
|
| Rate for Payer: Cash Price |
$56.64
|
| Rate for Payer: Cash Price |
$56.64
|
| Rate for Payer: Cigna of CA HMO |
$80.55
|
| Rate for Payer: Cigna of CA PPO |
$93.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.34
|
| Rate for Payer: EPIC Health Plan Senior |
$50.34
|
| Rate for Payer: Galaxy Health WC |
$106.98
|
| Rate for Payer: Global Benefits Group Commercial |
$75.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.10
|
| Rate for Payer: Multiplan Commercial |
$100.69
|
| Rate for Payer: Networks By Design Commercial |
$81.81
|
| Rate for Payer: Prime Health Services Commercial |
$106.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.93
|
| Rate for Payer: United Healthcare All Other HMO |
$62.93
|
| Rate for Payer: United Healthcare HMO Rider |
$62.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.98
|
| Rate for Payer: Vantage Medical Group Senior |
$106.98
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
|
IP
|
$125.86
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$106.98 |
| Rate for Payer: Adventist Health Commercial |
$25.17
|
| Rate for Payer: Cash Price |
$56.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.34
|
| Rate for Payer: EPIC Health Plan Senior |
$50.34
|
| Rate for Payer: Galaxy Health WC |
$106.98
|
| Rate for Payer: Global Benefits Group Commercial |
$75.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.21
|
| Rate for Payer: Multiplan Commercial |
$100.69
|
| Rate for Payer: Networks By Design Commercial |
$81.81
|
| Rate for Payer: Prime Health Services Commercial |
$106.98
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
|
IP
|
$105.56
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$89.73 |
| Rate for Payer: Adventist Health Commercial |
$21.11
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.22
|
| Rate for Payer: EPIC Health Plan Senior |
$42.22
|
| Rate for Payer: Galaxy Health WC |
$89.73
|
| Rate for Payer: Global Benefits Group Commercial |
$63.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.33
|
| Rate for Payer: Multiplan Commercial |
$84.45
|
| Rate for Payer: Networks By Design Commercial |
$68.61
|
| Rate for Payer: Prime Health Services Commercial |
$89.73
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
|
OP
|
$105.56
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$89.73 |
| Rate for Payer: Adventist Health Commercial |
$21.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.74
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna of CA HMO |
$67.56
|
| Rate for Payer: Cigna of CA PPO |
$78.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.22
|
| Rate for Payer: EPIC Health Plan Senior |
$42.22
|
| Rate for Payer: Galaxy Health WC |
$89.73
|
| Rate for Payer: Global Benefits Group Commercial |
$63.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.89
|
| Rate for Payer: Multiplan Commercial |
$84.45
|
| Rate for Payer: Networks By Design Commercial |
$68.61
|
| Rate for Payer: Prime Health Services Commercial |
$89.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.78
|
| Rate for Payer: United Healthcare All Other HMO |
$52.78
|
| Rate for Payer: United Healthcare HMO Rider |
$52.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.73
|
| Rate for Payer: Vantage Medical Group Senior |
$89.73
|
|
|
HC TRAY CATH COUDE URN MTR 16FR
|
Facility
|
OP
|
$153.37
|
|
| Hospital Charge Code |
901608086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Adventist Health Commercial |
$30.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.42
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cigna of CA HMO |
$98.16
|
| Rate for Payer: Cigna of CA PPO |
$113.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.35
|
| Rate for Payer: EPIC Health Plan Senior |
$61.35
|
| Rate for Payer: Galaxy Health WC |
$130.36
|
| Rate for Payer: Global Benefits Group Commercial |
$92.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.36
|
| Rate for Payer: Multiplan Commercial |
$122.70
|
| Rate for Payer: Networks By Design Commercial |
$99.69
|
| Rate for Payer: Prime Health Services Commercial |
$130.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.69
|
| Rate for Payer: United Healthcare All Other HMO |
$76.69
|
| Rate for Payer: United Healthcare HMO Rider |
$76.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.36
|
| Rate for Payer: Vantage Medical Group Senior |
$130.36
|
|
|
HC TRAY CATH COUDE URN MTR 16FR
|
Facility
|
IP
|
$153.37
|
|
| Hospital Charge Code |
901608086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Adventist Health Commercial |
$30.67
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.35
|
| Rate for Payer: EPIC Health Plan Senior |
$61.35
|
| Rate for Payer: Galaxy Health WC |
$130.36
|
| Rate for Payer: Global Benefits Group Commercial |
$92.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.81
|
| Rate for Payer: Multiplan Commercial |
$122.70
|
| Rate for Payer: Networks By Design Commercial |
$99.69
|
| Rate for Payer: Prime Health Services Commercial |
$130.36
|
|
|
HC TRAY CATH PICC POWER 3FR SL
|
Facility
|
OP
|
$906.38
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901606420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.28 |
| Max. Negotiated Rate |
$770.42 |
| Rate for Payer: Adventist Health Commercial |
$181.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$770.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$498.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$679.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$548.63
|
| Rate for Payer: Blue Shield of California Commercial |
$459.53
|
| Rate for Payer: Blue Shield of California Commercial |
$697.01
|
| Rate for Payer: Cash Price |
$407.87
|
| Rate for Payer: Cigna of CA HMO |
$634.47
|
| Rate for Payer: Cigna of CA PPO |
$634.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$770.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$634.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.55
|
| Rate for Payer: EPIC Health Plan Senior |
$362.55
|
| Rate for Payer: Galaxy Health WC |
$770.42
|
| Rate for Payer: Global Benefits Group Commercial |
$543.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$575.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$329.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$634.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$634.47
|
| Rate for Payer: Multiplan Commercial |
$725.10
|
| Rate for Payer: Networks By Design Commercial |
$453.19
|
| Rate for Payer: Prime Health Services Commercial |
$770.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$543.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.16
|
| Rate for Payer: United Healthcare All Other HMO |
$331.10
|
| Rate for Payer: United Healthcare HMO Rider |
$323.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$770.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.42
|
| Rate for Payer: Vantage Medical Group Senior |
$770.42
|
|
