|
HC ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$4,555.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
900200215
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$911.00 |
| Max. Negotiated Rate |
$3,871.75 |
| Rate for Payer: Adventist Health Commercial |
$911.00
|
| Rate for Payer: Cash Price |
$2,049.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,822.00
|
| Rate for Payer: Galaxy Health WC |
$3,871.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,733.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,038.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,735.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,819.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.20
|
| Rate for Payer: Multiplan Commercial |
$3,644.00
|
| Rate for Payer: Networks By Design Commercial |
$2,960.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,871.75
|
|
|
HC ECHO TRANSESOPHAGEAL (TEE)
|
Facility
|
OP
|
$10,466.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
900293355
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$324.68 |
| Max. Negotiated Rate |
$8,896.10 |
| Rate for Payer: Adventist Health Commercial |
$2,093.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,864.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,896.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,756.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,849.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6,405.19
|
| Rate for Payer: Blue Shield of California EPN |
$4,228.26
|
| Rate for Payer: Cash Price |
$4,709.70
|
| Rate for Payer: Cash Price |
$4,709.70
|
| Rate for Payer: Cash Price |
$4,709.70
|
| Rate for Payer: Cigna of CA HMO |
$6,698.24
|
| Rate for Payer: Cigna of CA PPO |
$7,744.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,896.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,896.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,896.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,186.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,186.40
|
| Rate for Payer: Galaxy Health WC |
$8,896.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,279.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,980.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,478.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,511.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,326.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,326.20
|
| Rate for Payer: Multiplan Commercial |
$8,372.80
|
| Rate for Payer: Networks By Design Commercial |
$6,802.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,896.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,279.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,279.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,896.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,896.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,896.10
|
|
|
HC ECHO TRANSESOPHAGEAL (TEE)
|
Facility
|
IP
|
$10,466.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
900293355
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,093.20 |
| Max. Negotiated Rate |
$8,896.10 |
| Rate for Payer: Adventist Health Commercial |
$2,093.20
|
| Rate for Payer: Cash Price |
$4,709.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,186.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,186.40
|
| Rate for Payer: Galaxy Health WC |
$8,896.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,279.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,980.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,987.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,478.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,511.84
|
| Rate for Payer: Multiplan Commercial |
$8,372.80
|
| Rate for Payer: Networks By Design Commercial |
$6,802.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,896.10
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
|
IP
|
$4,537.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$907.40 |
| Max. Negotiated Rate |
$3,856.45 |
| Rate for Payer: Adventist Health Commercial |
$907.40
|
| Rate for Payer: Cash Price |
$2,041.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,814.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,814.80
|
| Rate for Payer: Galaxy Health WC |
$3,856.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,722.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,026.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,728.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,808.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,088.88
|
| Rate for Payer: Multiplan Commercial |
$3,629.60
|
| Rate for Payer: Networks By Design Commercial |
$2,949.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,856.45
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
|
OP
|
$4,537.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$402.80 |
| Max. Negotiated Rate |
$3,856.45 |
| Rate for Payer: Adventist Health Commercial |
$907.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,975.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,786.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2,776.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,832.95
|
| Rate for Payer: Cash Price |
$2,041.65
|
| Rate for Payer: Cash Price |
$2,041.65
|
| Rate for Payer: Cash Price |
$2,041.65
|
| Rate for Payer: Cigna of CA HMO |
$2,903.68
|
| Rate for Payer: Cigna of CA PPO |
$3,357.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$3,856.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,722.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$402.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,026.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,088.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$3,629.60
|
| Rate for Payer: Networks By Design Commercial |
$2,949.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,856.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,722.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,722.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC ECMO CIRCUIT & SET-UP INITIAL
|
Facility
|
IP
|
$37,606.00
|
|
| Hospital Charge Code |
900190010
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$7,521.20 |
| Max. Negotiated Rate |
$31,965.10 |
| Rate for Payer: Adventist Health Commercial |
$7,521.20
|
| Rate for Payer: Cash Price |
$16,922.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,042.40
|
| Rate for Payer: EPIC Health Plan Senior |
$15,042.40
|
| Rate for Payer: Galaxy Health WC |
$31,965.10
|
| Rate for Payer: Global Benefits Group Commercial |
$22,563.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,083.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,327.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,278.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,025.44
|
| Rate for Payer: Multiplan Commercial |
$30,084.80
|
| Rate for Payer: Networks By Design Commercial |
$24,443.90
|
| Rate for Payer: Prime Health Services Commercial |
$31,965.10
|
|
|
HC ECMO CIRCUIT & SET-UP INITIAL
|
Facility
|
OP
|
$37,606.00
|
|
| Hospital Charge Code |
900190010
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$31,965.10 |
| Rate for Payer: Adventist Health Commercial |
$7,521.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,665.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,965.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,683.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$16,922.70
|
| Rate for Payer: Cash Price |
$16,922.70
|
| Rate for Payer: Cash Price |
$16,922.70
|
| Rate for Payer: Cigna of CA HMO |
$24,067.84
|
| Rate for Payer: Cigna of CA PPO |
$27,828.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,965.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,965.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,965.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,042.40
|
| Rate for Payer: EPIC Health Plan Senior |
$15,042.40
|
| Rate for Payer: Galaxy Health WC |
$31,965.10
|
| Rate for Payer: Global Benefits Group Commercial |
$22,563.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,083.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,327.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,278.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,025.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,324.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,324.20
|
| Rate for Payer: Multiplan Commercial |
$30,084.80
|
| Rate for Payer: Networks By Design Commercial |
$24,443.90
|
| Rate for Payer: Prime Health Services Commercial |
$31,965.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,563.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,563.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,965.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,965.10
|
| Rate for Payer: Vantage Medical Group Senior |
$31,965.10
|
|
|
HC ECMO EQUIP & MONITOR EA 4 HRS
|
Facility
|
OP
|
$1,013.00
|
|
| Hospital Charge Code |
900190021
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$202.60 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$664.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO |
$648.32
|
| Rate for Payer: Cigna of CA PPO |
$749.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$861.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: EPIC Health Plan Senior |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$627.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$709.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$709.10
|
| Rate for Payer: Multiplan Commercial |
$810.40
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.05
|
| Rate for Payer: Vantage Medical Group Senior |
$861.05
|
|
|
HC ECMO EQUIP & MONITOR EA 4 HRS
|
Facility
|
IP
|
$1,013.00
|
|
| Hospital Charge Code |
900190021
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$202.60 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: EPIC Health Plan Senior |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$627.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.12
|
| Rate for Payer: Multiplan Commercial |
$810.40
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
|
|
HC ECMO RE-PRIME BLADDER
|
Facility
|
OP
|
$1,809.00
|
|
| Hospital Charge Code |
900190033
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$361.80 |
| Max. Negotiated Rate |
$1,537.65 |
| Rate for Payer: Adventist Health Commercial |
$361.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,186.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,537.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$814.05
|
| Rate for Payer: Cash Price |
$814.05
|
| Rate for Payer: Cash Price |
$814.05
|
| Rate for Payer: Cigna of CA HMO |
$1,157.76
|
| Rate for Payer: Cigna of CA PPO |
$1,338.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,537.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,537.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,537.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.60
|
| Rate for Payer: EPIC Health Plan Senior |
$723.60
|
| Rate for Payer: Galaxy Health WC |
$1,537.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,085.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,206.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$689.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,266.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,266.30
|
| Rate for Payer: Multiplan Commercial |
$1,447.20
|
| Rate for Payer: Networks By Design Commercial |
$1,175.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,537.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,085.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,085.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,537.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,537.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,537.65
|
|
|
HC ECMO RE-PRIME BLADDER
|
Facility
|
IP
|
$1,809.00
|
|
| Hospital Charge Code |
900190033
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$361.80 |
| Max. Negotiated Rate |
$1,537.65 |
| Rate for Payer: Adventist Health Commercial |
$361.80
|
| Rate for Payer: Cash Price |
$814.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.60
|
| Rate for Payer: EPIC Health Plan Senior |
$723.60
|
| Rate for Payer: Galaxy Health WC |
$1,537.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,085.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,206.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$689.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.16
|
| Rate for Payer: Multiplan Commercial |
$1,447.20
|
| Rate for Payer: Networks By Design Commercial |
$1,175.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,537.65
|
|
|
HC ECMO RE-PRIME CANNULAE
|
Facility
|
OP
|
$845.00
|
|
| Hospital Charge Code |
900190036
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$718.25 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$554.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$718.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cigna of CA HMO |
$540.80
|
| Rate for Payer: Cigna of CA PPO |
$625.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$718.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$718.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$718.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Senior |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$591.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$591.50
|
| Rate for Payer: Multiplan Commercial |
$676.00
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$718.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$718.25
|
| Rate for Payer: Vantage Medical Group Senior |
$718.25
|
|
|
HC ECMO RE-PRIME CANNULAE
|
Facility
|
IP
|
$845.00
|
|
| Hospital Charge Code |
900190036
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$718.25 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Senior |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$676.00
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
|
OP
|
$13,645.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$11,598.25 |
| Rate for Payer: Adventist Health Commercial |
$2,729.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,949.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,598.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,504.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,233.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$6,140.25
|
| Rate for Payer: Cash Price |
$6,140.25
|
| Rate for Payer: Cash Price |
$6,140.25
|
| Rate for Payer: Cigna of CA HMO |
$8,732.80
|
| Rate for Payer: Cigna of CA PPO |
$10,097.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,598.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,598.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,598.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,458.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,458.00
|
| Rate for Payer: Galaxy Health WC |
$11,598.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,187.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,101.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,198.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,446.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,274.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,551.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,551.50
|
| Rate for Payer: Multiplan Commercial |
$10,916.00
|
| Rate for Payer: Networks By Design Commercial |
$8,869.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,598.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,187.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,187.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,598.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,598.25
|
| Rate for Payer: Vantage Medical Group Senior |
$11,598.25
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
|
IP
|
$13,645.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$2,729.00 |
| Max. Negotiated Rate |
$11,598.25 |
| Rate for Payer: Adventist Health Commercial |
$2,729.00
|
| Rate for Payer: Cash Price |
$6,140.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,458.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,458.00
|
| Rate for Payer: Galaxy Health WC |
$11,598.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,187.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,101.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,198.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,446.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,274.80
|
| Rate for Payer: Multiplan Commercial |
$10,916.00
|
| Rate for Payer: Networks By Design Commercial |
$8,869.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,598.25
|
|
|
HC ECMO RE-PRIME HEAT EXCHANGE
|
Facility
|
IP
|
$2,519.00
|
|
| Hospital Charge Code |
900190032
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$503.80 |
| Max. Negotiated Rate |
$2,141.15 |
| Rate for Payer: Adventist Health Commercial |
$503.80
|
| Rate for Payer: Cash Price |
$1,133.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,007.60
|
| Rate for Payer: Galaxy Health WC |
$2,141.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,511.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,680.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$959.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,559.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.56
|
| Rate for Payer: Multiplan Commercial |
$2,015.20
|
| Rate for Payer: Networks By Design Commercial |
$1,637.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,141.15
|
|
|
HC ECMO RE-PRIME HEAT EXCHANGE
|
Facility
|
OP
|
$2,519.00
|
|
| Hospital Charge Code |
900190032
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$2,141.15 |
| Rate for Payer: Adventist Health Commercial |
$503.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,652.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,141.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,385.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,889.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$1,133.55
|
| Rate for Payer: Cash Price |
$1,133.55
|
| Rate for Payer: Cash Price |
$1,133.55
|
| Rate for Payer: Cigna of CA HMO |
$1,612.16
|
| Rate for Payer: Cigna of CA PPO |
$1,864.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,141.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,141.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,141.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,007.60
|
| Rate for Payer: Galaxy Health WC |
$2,141.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,511.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,680.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$959.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,559.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,763.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,763.30
|
| Rate for Payer: Multiplan Commercial |
$2,015.20
|
| Rate for Payer: Networks By Design Commercial |
$1,637.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,141.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,511.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,511.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,141.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,141.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,141.15
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
OP
|
$1,107.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$940.95 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$726.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$940.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$830.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cigna of CA HMO |
$708.48
|
| Rate for Payer: Cigna of CA PPO |
$819.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$940.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$940.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$940.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: EPIC Health Plan Senior |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$685.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$774.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$774.90
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$664.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$940.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$940.95
|
| Rate for Payer: Vantage Medical Group Senior |
$940.95
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
IP
|
$1,107.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$940.95 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: EPIC Health Plan Senior |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$685.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.68
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
IP
|
$5,526.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$1,105.20 |
| Max. Negotiated Rate |
$4,697.10 |
| Rate for Payer: Adventist Health Commercial |
$1,105.20
|
| Rate for Payer: Cash Price |
$2,486.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,210.40
|
| Rate for Payer: Galaxy Health WC |
$4,697.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,315.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,685.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,105.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,420.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.24
|
| Rate for Payer: Multiplan Commercial |
$4,420.80
|
| Rate for Payer: Networks By Design Commercial |
$3,591.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.10
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
OP
|
$5,526.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$4,697.10 |
| Rate for Payer: Adventist Health Commercial |
$1,105.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,624.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,697.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,039.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,144.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$2,486.70
|
| Rate for Payer: Cash Price |
$2,486.70
|
| Rate for Payer: Cash Price |
$2,486.70
|
| Rate for Payer: Cigna of CA HMO |
$3,536.64
|
| Rate for Payer: Cigna of CA PPO |
$4,089.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,697.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,697.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,697.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,210.40
|
| Rate for Payer: Galaxy Health WC |
$4,697.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,315.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,685.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,105.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,420.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,868.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,868.20
|
| Rate for Payer: Multiplan Commercial |
$4,420.80
|
| Rate for Payer: Networks By Design Commercial |
$3,591.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,697.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,697.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,697.10
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
OP
|
$563.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$112.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$369.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Cigna of CA HMO |
$360.32
|
| Rate for Payer: Cigna of CA PPO |
$416.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.10
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.55
|
| Rate for Payer: Vantage Medical Group Senior |
$478.55
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
IP
|
$563.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$478.55 |
| Rate for Payer: Adventist Health Commercial |
$112.60
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.12
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
OP
|
$3,555.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$3,021.75 |
| Rate for Payer: Adventist Health Commercial |
$711.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,331.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,021.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,955.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,666.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$1,599.75
|
| Rate for Payer: Cash Price |
$1,599.75
|
| Rate for Payer: Cash Price |
$1,599.75
|
| Rate for Payer: Cigna of CA HMO |
$2,275.20
|
| Rate for Payer: Cigna of CA PPO |
$2,630.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,021.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,021.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,021.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,422.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,422.00
|
| Rate for Payer: Galaxy Health WC |
$3,021.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,133.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,371.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,354.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,200.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,488.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,488.50
|
| Rate for Payer: Multiplan Commercial |
$2,844.00
|
| Rate for Payer: Networks By Design Commercial |
$2,310.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,021.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,133.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,133.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,021.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,021.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,021.75
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
IP
|
$3,555.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$3,021.75 |
| Rate for Payer: Adventist Health Commercial |
$711.00
|
| Rate for Payer: Cash Price |
$1,599.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,422.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,422.00
|
| Rate for Payer: Galaxy Health WC |
$3,021.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,133.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,371.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,354.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,200.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.20
|
| Rate for Payer: Multiplan Commercial |
$2,844.00
|
| Rate for Payer: Networks By Design Commercial |
$2,310.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,021.75
|
|
