|
HC YANKAUER FINE CAP FLANGE
|
Facility
|
OP
|
$4.59
|
|
| Hospital Charge Code |
901607936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3.90
|
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.95
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.90
|
|
|
HC YANKAUER FLANGE TIP FINE CAP
|
Facility
|
OP
|
$7.05
|
|
| Hospital Charge Code |
901698750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.52
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cigna of CA HMO |
$4.51
|
| Rate for Payer: Cigna of CA PPO |
$5.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.93
|
| Rate for Payer: Multiplan Commercial |
$5.64
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC YANKAUER FLANGE TIP FINE CAP
|
Facility
|
IP
|
$7.05
|
|
| Hospital Charge Code |
901698750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$5.64
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
|
|
HC YANKAUER FLEX W/FLANGE TIP STL
|
Facility
|
OP
|
$4.59
|
|
| Hospital Charge Code |
901698717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.95
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3.90
|
|
|
HC YANKAUER FLEX W/FLANGE TIP STL
|
Facility
|
IP
|
$4.59
|
|
| Hospital Charge Code |
901698717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
|
|
HC YANKAUER REG CAP FLANGE
|
Facility
|
IP
|
$4.43
|
|
| Hospital Charge Code |
901607937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
|
|
HC YANKAUER REG CAP FLANGE
|
Facility
|
OP
|
$4.43
|
|
| Hospital Charge Code |
901607937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.84
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
HC YANKAUER RIGID W/FLANGE TIP
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.89
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$2.89
|
| Rate for Payer: Cigna of CA PPO |
$3.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$3.61
|
| Rate for Payer: Networks By Design Commercial |
$2.93
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.83
|
|
|
HC YANKAUER RIGID W/FLANGE TIP
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.61
|
| Rate for Payer: Networks By Design Commercial |
$2.93
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
|
|
HC YANKAUER RIGID W/OPEN TIP STL
|
Facility
|
OP
|
$4.35
|
|
| Hospital Charge Code |
901698716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.79
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
HC YANKAUER RIGID W/OPEN TIP STL
|
Facility
|
IP
|
$4.35
|
|
| Hospital Charge Code |
901698716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
HC YANKAUER SUCTN FLEXI FINE CAP
|
Facility
|
OP
|
$4.43
|
|
| Hospital Charge Code |
901698615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.84
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
HC YANKAUER SUCTN FLEXI FINE CAP
|
Facility
|
IP
|
$4.43
|
|
| Hospital Charge Code |
901698615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
|
|
HC YANKAUER TIP ON/OFF CNTRL
|
Facility
|
IP
|
$9.92
|
|
| Hospital Charge Code |
901607946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Senior |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.94
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
|
|
HC YANKAUER TIP ON/OFF CNTRL
|
Facility
|
OP
|
$9.92
|
|
| Hospital Charge Code |
901607946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cigna of CA HMO |
$6.35
|
| Rate for Payer: Cigna of CA PPO |
$7.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Senior |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$7.94
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.43
|
| Rate for Payer: Vantage Medical Group Senior |
$8.43
|
|
|
HC ZELANTE CATHETER
|
Facility
|
IP
|
$8,798.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna of CA HMO |
$6,158.60
|
| Rate for Payer: Cigna of CA PPO |
$6,158.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,158.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,519.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,519.20
|
| Rate for Payer: Galaxy Health WC |
$7,478.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,278.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,586.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,190.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,111.52
|
| Rate for Payer: Multiplan Commercial |
$7,038.40
|
| Rate for Payer: Networks By Design Commercial |
$4,399.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,478.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,301.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,213.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,144.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.34
|
|
|
HC ZELANTE CATHETER
|
Facility
|
OP
|
$8,798.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.60 |
| Max. Negotiated Rate |
$7,478.30 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,838.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,598.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,325.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4,460.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6,765.66
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna of CA HMO |
$6,158.60
|
| Rate for Payer: Cigna of CA PPO |
$6,158.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,478.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,478.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,158.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,519.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,519.20
|
| Rate for Payer: Galaxy Health WC |
$7,478.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,278.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,586.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,193.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,190.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,111.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,158.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,158.60
|
| Rate for Payer: Multiplan Commercial |
$7,038.40
|
| Rate for Payer: Networks By Design Commercial |
$4,399.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,478.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,278.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,278.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,301.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,213.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,144.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,478.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7,478.30
|
|
|
HEADACHES WITH MCC
|
Facility
|
IP
|
$99,139.79
|
|
|
Service Code
|
MSDRG 102
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$99,139.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,981.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,139.79
|
| Rate for Payer: EPIC Health Plan Senior |
$66,093.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,084.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,118.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,513.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
HEADACHES WITHOUT MCC
|
Facility
|
IP
|
$94,089.62
|
|
|
Service Code
|
MSDRG 103
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$94,089.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,353.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$94,089.62
|
| Rate for Payer: EPIC Health Plan Senior |
$62,726.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,024.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,833.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,412.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$28,727.89
|
|
|
Service Code
|
APR-DRG 0553
|
| Min. Negotiated Rate |
$22,944.51 |
| Max. Negotiated Rate |
$28,727.89 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,944.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,727.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,703.90
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$18,593.59
|
|
|
Service Code
|
APR-DRG 0552
|
| Min. Negotiated Rate |
$14,850.41 |
| Max. Negotiated Rate |
$18,593.59 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,850.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,593.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,636.37
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$64,969.72
|
|
|
Service Code
|
APR-DRG 0554
|
| Min. Negotiated Rate |
$51,890.29 |
| Max. Negotiated Rate |
$64,969.72 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51,890.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64,969.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58,130.80
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$13,076.43
|
|
|
Service Code
|
APR-DRG 0551
|
| Min. Negotiated Rate |
$10,443.94 |
| Max. Negotiated Rate |
$13,076.43 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,443.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,076.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,699.96
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$199,621.43
|
|
|
Service Code
|
APR-DRG 0021
|
| Min. Negotiated Rate |
$159,434.48 |
| Max. Negotiated Rate |
$199,621.43 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$159,434.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199,621.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178,608.65
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$337,376.62
|
|
|
Service Code
|
APR-DRG 0023
|
| Min. Negotiated Rate |
$269,457.38 |
| Max. Negotiated Rate |
$337,376.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$269,457.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337,376.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$301,863.29
|
|
