|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
OP
|
$82,271.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$69,930.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,933.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69,930.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45,249.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45,249.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$49,362.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cigna of CA PPO |
$60,880.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Dignity Health Media |
$69,930.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$69,930.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,908.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$32,908.40
|
| Rate for Payer: Galaxy Health WC |
$69,930.35
|
| Rate for Payer: Global Benefits Group Commercial |
$49,362.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$61,703.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54,874.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,345.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,745.04
|
| Rate for Payer: Multiplan Commercial |
$65,816.80
|
| Rate for Payer: Networks By Design Commercial |
$53,476.15
|
| Rate for Payer: Prime Health Services Commercial |
$69,930.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$49,362.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49,362.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69,930.35
|
| Rate for Payer: Vantage Medical Group Senior |
$69,930.35
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
IP
|
$82,271.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19,745.04 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,908.40
|
| Rate for Payer: Galaxy Health WC |
$69,930.35
|
| Rate for Payer: Global Benefits Group Commercial |
$49,362.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54,874.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,345.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,745.04
|
| Rate for Payer: Multiplan Commercial |
$65,816.80
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$69,930.35
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,339.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,055.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,639.64
|
| Rate for Payer: BCBS Transplant Transplant |
$1,651.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,626.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,290.69
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cigna of CA HMO |
$1,761.28
|
| Rate for Payer: Cigna of CA PPO |
$2,036.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,339.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,651.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,064.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,835.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: Networks By Design Commercial |
$1,788.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,339.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,651.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,651.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,651.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$660.48 |
| Max. Negotiated Rate |
$2,339.20 |
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,100.80
|
| Rate for Payer: Galaxy Health WC |
$2,339.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,651.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,835.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,048.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.48
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: Networks By Design Commercial |
$1,788.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,339.20
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
OP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$416.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$378.33
|
| Rate for Payer: BCBS Transplant Transplant |
$381.00
|
| Rate for Payer: Blue Shield of California Commercial |
$375.28
|
| Rate for Payer: Blue Shield of California EPN |
$297.82
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cigna of CA HMO |
$406.40
|
| Rate for Payer: Cigna of CA PPO |
$469.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$476.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: IEHP Medi-Cal |
$316.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$316.18
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$508.00
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$381.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
IP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$539.75 |
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.00
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.40
|
| Rate for Payer: Multiplan Commercial |
$508.00
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
|
|
HC TRANSFERRIN
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.90
|
| Rate for Payer: BCBS Transplant Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.09
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Media |
$12.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.76
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$20.93
|
| Rate for Payer: IEHP Medi-Cal |
$20.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$20.67
|
| Rate for Payer: IEHP Medicare Advantage |
$12.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$542.38 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,538.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,889.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,497.38
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna of CA HMO |
$1,640.96
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,923.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: IEHP Medi-Cal |
$878.66
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$878.66
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
IP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$615.36 |
| Max. Negotiated Rate |
$2,179.40 |
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$542.38 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,538.40
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,923.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,282.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,282.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
IP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$615.36 |
| Max. Negotiated Rate |
$2,179.40 |
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
IP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
940100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$615.36 |
| Max. Negotiated Rate |
$2,179.40 |
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
940100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$542.38 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,538.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,889.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,497.38
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna of CA HMO |
$1,640.96
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,923.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: IEHP Medi-Cal |
$878.66
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$878.66
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$365.76 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$914.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,123.19
|
| Rate for Payer: Blue Shield of California EPN |
$890.02
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna of CA HMO |
$975.36
|
| Rate for Payer: Cigna of CA PPO |
$1,127.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,295.40
|
| Rate for Payer: Global Benefits Group Commercial |
$914.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,143.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: IEHP Medi-Cal |
$878.66
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$878.66
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: Networks By Design Commercial |
$990.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,295.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$914.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$914.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$914.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$365.76 |
| Max. Negotiated Rate |
$1,295.40 |
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$609.60
|
| Rate for Payer: Galaxy Health WC |
$1,295.40
|
| Rate for Payer: Global Benefits Group Commercial |
$914.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$580.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.76
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: Networks By Design Commercial |
$990.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,295.40
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$365.76 |
| Max. Negotiated Rate |
$1,295.40 |
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$609.60
|
| Rate for Payer: Galaxy Health WC |
$1,295.40
|
| Rate for Payer: Global Benefits Group Commercial |
$914.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$580.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.76
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: Networks By Design Commercial |
$990.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,295.40
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$365.76 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$914.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,123.19
|
| Rate for Payer: Blue Shield of California EPN |
$890.02
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna of CA HMO |
$975.36
|
| Rate for Payer: Cigna of CA PPO |
$1,127.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,295.40
|
| Rate for Payer: Global Benefits Group Commercial |
$914.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,143.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: IEHP Medi-Cal |
$878.66
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$878.66
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: Networks By Design Commercial |
$990.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,295.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$914.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$914.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$914.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$213.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.45
|
| Rate for Payer: BCBS Transplant Transplant |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.42
|
| Rate for Payer: Blue Shield of California EPN |
$22.53
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.91
|
| Rate for Payer: IEHP Medi-Cal |
$18.68
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$18.68
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TRANSTHYRETIN
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$133.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$121.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.47
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.88
|
| Rate for Payer: Dignity Health Media |
$14.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.59
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.93
|
| Rate for Payer: IEHP Medi-Cal |
$23.64
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$23.64
|
| Rate for Payer: IEHP Medicare Advantage |
$14.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.55
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO |
$11.82
|
| Rate for Payer: United Healthcare HMO Rider |
$11.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14.59
|
|
|
HC TRAUMA ACTIVATION LEVEL A
|
Facility
IP
|
$65,249.00
|
|
| Hospital Charge Code |
904300100
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$12,503.00 |
| Max. Negotiated Rate |
$55,461.65 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,503.00
|
| Rate for Payer: Cash Price |
$29,362.05
|
| Rate for Payer: Cash Price |
$29,362.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,099.60
|
| Rate for Payer: Galaxy Health WC |
$55,461.65
|
| Rate for Payer: Global Benefits Group Commercial |
$39,149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43,521.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,859.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,659.76
|
| Rate for Payer: Multiplan Commercial |
$52,199.20
|
| Rate for Payer: Prime Health Services Commercial |
$55,461.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,193.86
|
| Rate for Payer: United Healthcare All Other HMO |
$29,694.82
|
| Rate for Payer: United Healthcare HMO Rider |
$28,507.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26,066.98
|
|
|
HC TRAUMA ACTIVATION LEVEL A
|
Facility
OP
|
$65,249.00
|
|
| Hospital Charge Code |
904300100
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$9,762.00 |
| Max. Negotiated Rate |
$55,461.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,798.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55,461.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35,886.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35,886.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,762.00
|
| Rate for Payer: BCBS Transplant Transplant |
$39,149.40
|
| Rate for Payer: Blue Shield of California Commercial |
$48,088.51
|
| Rate for Payer: Blue Shield of California EPN |
$38,105.42
|
| Rate for Payer: Cash Price |
$29,362.05
|
| Rate for Payer: Cash Price |
$29,362.05
|
| Rate for Payer: Cigna of CA PPO |
$48,284.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55,461.65
|
| Rate for Payer: Dignity Health Media |
$55,461.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$55,461.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,099.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$26,099.60
|
| Rate for Payer: Galaxy Health WC |
$55,461.65
|
| Rate for Payer: Global Benefits Group Commercial |
$39,149.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48,936.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43,521.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,859.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,659.76
|
| Rate for Payer: Multiplan Commercial |
$52,199.20
|
| Rate for Payer: Networks By Design Commercial |
$55,461.65
|
| Rate for Payer: Prime Health Services Commercial |
$55,461.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$39,149.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39,149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39,149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,193.86
|
| Rate for Payer: United Healthcare All Other HMO |
$29,694.82
|
| Rate for Payer: United Healthcare HMO Rider |
$28,507.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26,066.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55,461.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55,461.65
|
| Rate for Payer: Vantage Medical Group Senior |
$55,461.65
|
|
|
HC TRAUMA ACTIVATION LEVEL B
|
Facility
IP
|
$38,814.00
|
|
| Hospital Charge Code |
904300101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$9,315.36 |
| Max. Negotiated Rate |
$32,991.90 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,503.00
|
| Rate for Payer: Cash Price |
$17,466.30
|
| Rate for Payer: Cash Price |
$17,466.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,525.60
|
| Rate for Payer: Galaxy Health WC |
$32,991.90
|
| Rate for Payer: Global Benefits Group Commercial |
$23,288.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,888.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,788.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,315.36
|
| Rate for Payer: Multiplan Commercial |
$31,051.20
|
| Rate for Payer: Prime Health Services Commercial |
$32,991.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,150.83
|
| Rate for Payer: United Healthcare All Other HMO |
$17,664.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16,957.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,506.19
|
|
|
HC TRAUMA ACTIVATION LEVEL B
|
Facility
OP
|
$38,814.00
|
|
| Hospital Charge Code |
904300101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$9,315.36 |
| Max. Negotiated Rate |
$32,991.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,622.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,991.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21,347.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,347.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,762.00
|
| Rate for Payer: BCBS Transplant Transplant |
$23,288.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28,605.92
|
| Rate for Payer: Blue Shield of California EPN |
$22,667.38
|
| Rate for Payer: Cash Price |
$17,466.30
|
| Rate for Payer: Cash Price |
$17,466.30
|
| Rate for Payer: Cigna of CA PPO |
$28,722.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,991.90
|
| Rate for Payer: Dignity Health Media |
$32,991.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,991.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,525.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15,525.60
|
| Rate for Payer: Galaxy Health WC |
$32,991.90
|
| Rate for Payer: Global Benefits Group Commercial |
$23,288.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29,110.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,888.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,788.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,315.36
|
| Rate for Payer: Multiplan Commercial |
$31,051.20
|
| Rate for Payer: Networks By Design Commercial |
$32,991.90
|
| Rate for Payer: Prime Health Services Commercial |
$32,991.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23,288.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,288.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,288.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,150.83
|
| Rate for Payer: United Healthcare All Other HMO |
$17,664.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16,957.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,506.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,991.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,991.90
|
| Rate for Payer: Vantage Medical Group Senior |
$32,991.90
|
|
|
HC TRAUMA ACTIVATION LEVEL C
|
Facility
OP
|
$17,142.00
|
|
| Hospital Charge Code |
904300102
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$4,114.08 |
| Max. Negotiated Rate |
$14,570.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,082.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,570.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,428.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,428.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,762.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,285.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,633.65
|
| Rate for Payer: Blue Shield of California EPN |
$10,010.93
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Cigna of CA PPO |
$12,685.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,570.70
|
| Rate for Payer: Dignity Health Media |
$14,570.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,570.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,856.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,856.80
|
| Rate for Payer: Galaxy Health WC |
$14,570.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,285.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,856.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,433.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.08
|
| Rate for Payer: Multiplan Commercial |
$13,713.60
|
| Rate for Payer: Networks By Design Commercial |
$14,570.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,570.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,285.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,285.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,285.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,457.86
|
| Rate for Payer: United Healthcare All Other HMO |
$7,801.32
|
| Rate for Payer: United Healthcare HMO Rider |
$7,489.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,848.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,570.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,570.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14,570.70
|
|
|
HC TRAUMA ACTIVATION LEVEL C
|
Facility
IP
|
$17,142.00
|
|
| Hospital Charge Code |
904300102
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$4,114.08 |
| Max. Negotiated Rate |
$14,570.70 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,503.00
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,856.80
|
| Rate for Payer: Galaxy Health WC |
$14,570.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,285.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,433.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.08
|
| Rate for Payer: Multiplan Commercial |
$13,713.60
|
| Rate for Payer: Prime Health Services Commercial |
$14,570.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,457.86
|
| Rate for Payer: United Healthcare All Other HMO |
$7,801.32
|
| Rate for Payer: United Healthcare HMO Rider |
$7,489.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,848.23
|
|
