|
HC ROOM REHAB ACUTE 1:4
|
Facility
|
IP
|
$4,721.00
|
|
| Hospital Charge Code |
992300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$944.20 |
| Max. Negotiated Rate |
$5,692.00 |
| Rate for Payer: Adventist Health Commercial |
$944.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,692.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,952.00
|
| Rate for Payer: Cash Price |
$2,124.45
|
| Rate for Payer: Cash Price |
$2,124.45
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,304.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,888.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,888.40
|
| Rate for Payer: Galaxy Health WC |
$4,012.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,832.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,747.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,997.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,785.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.04
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,012.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION
|
Facility
|
IP
|
$5,691.00
|
|
| Hospital Charge Code |
902300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,138.20 |
| Max. Negotiated Rate |
$5,692.00 |
| Rate for Payer: Adventist Health Commercial |
$1,138.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,692.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,952.00
|
| Rate for Payer: Cash Price |
$2,560.95
|
| Rate for Payer: Cash Price |
$2,560.95
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,983.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,276.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,276.40
|
| Rate for Payer: Galaxy Health WC |
$4,837.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,414.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,747.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,613.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,357.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,365.84
|
| Rate for Payer: Multiplan Commercial |
$4,552.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,837.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,420.00
|
|
| Hospital Charge Code |
992300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,084.00 |
| Max. Negotiated Rate |
$5,692.00 |
| Rate for Payer: Adventist Health Commercial |
$1,084.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,692.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,952.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,168.00
|
| Rate for Payer: Galaxy Health WC |
$4,607.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,747.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,441.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,197.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.80
|
| Rate for Payer: Multiplan Commercial |
$4,336.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE
|
Facility
|
IP
|
$7,085.00
|
|
| Hospital Charge Code |
902311817
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,417.00 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,417.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Cash Price |
$3,188.25
|
| Rate for Payer: Cash Price |
$3,188.25
|
| Rate for Payer: Cash Price |
$3,188.25
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,959.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,834.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,834.00
|
| Rate for Payer: Galaxy Health WC |
$6,022.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,251.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,498.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,180.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,700.40
|
| Rate for Payer: Multiplan Commercial |
$5,668.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,022.25
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$9,096.00
|
|
| Hospital Charge Code |
902311819
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,819.20 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,819.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Cash Price |
$4,093.20
|
| Rate for Payer: Cash Price |
$4,093.20
|
| Rate for Payer: Cash Price |
$4,093.20
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,367.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,638.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,638.40
|
| Rate for Payer: Galaxy Health WC |
$7,731.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,457.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,775.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,366.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.04
|
| Rate for Payer: Multiplan Commercial |
$7,276.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,731.60
|
|
|
HC ROOM TRAUMA ACUTE
|
Facility
|
IP
|
$7,883.00
|
|
| Hospital Charge Code |
902300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,576.60 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,576.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,841.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$3,547.35
|
| Rate for Payer: Cash Price |
$3,547.35
|
| Rate for Payer: Cash Price |
$3,547.35
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,518.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,153.20
|
| Rate for Payer: Galaxy Health WC |
$6,700.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,729.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,005.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,650.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,891.92
|
| Rate for Payer: Multiplan Commercial |
$6,306.40
|
| Rate for Payer: Networks By Design Commercial |
$5,123.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,700.55
|
|
|
HC ROOM TRAUMA ACUTE 1:4
|
Facility
|
IP
|
$6,054.00
|
|
| Hospital Charge Code |
992300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,210.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,841.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$2,724.30
|
| Rate for Payer: Cash Price |
$2,724.30
|
| Rate for Payer: Cash Price |
$2,724.30
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,237.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,421.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,421.60
|
| Rate for Payer: Galaxy Health WC |
$5,145.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,632.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,844.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,571.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.96
|
| Rate for Payer: Multiplan Commercial |
$4,843.20
|
| Rate for Payer: Networks By Design Commercial |
$3,935.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,145.90
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$8,236.00
|
|
| Hospital Charge Code |
902300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,647.20 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,647.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,765.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,294.40
|
| Rate for Payer: Galaxy Health WC |
$7,000.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,941.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,229.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,859.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,976.64
|
| Rate for Payer: Multiplan Commercial |
$6,588.80
|
| Rate for Payer: Networks By Design Commercial |
$5,353.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,000.60
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$7,844.00
|
|
| Hospital Charge Code |
992300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,568.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,490.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,137.60
|
| Rate for Payer: Galaxy Health WC |
$6,667.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,706.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,980.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,627.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.56
|
| Rate for Payer: Multiplan Commercial |
$6,275.20
|
| Rate for Payer: Networks By Design Commercial |
$5,098.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,667.40
|
|
|
HC ROOM TRAUMA DOU/INTEREDIATE ISOLATION
|
Facility
|
IP
|
$12,136.00
|
|
| Hospital Charge Code |
902311719
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,427.20 |
| Max. Negotiated Rate |
$10,315.60 |
| Rate for Payer: Adventist Health Commercial |
$2,427.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,854.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,854.40
|
| Rate for Payer: Galaxy Health WC |
$10,315.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,281.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,706.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,160.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,912.64
|
| Rate for Payer: Multiplan Commercial |
$9,708.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,315.60
|
|
|
HC ROOM TRAUMA DOU/INTERMEDIATE
|
Facility
|
IP
|
$10,129.00
|
|
| Hospital Charge Code |
902311717
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,025.80 |
| Max. Negotiated Rate |
$8,609.65 |
| Rate for Payer: Adventist Health Commercial |
$2,025.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Cash Price |
$4,558.05
|
| Rate for Payer: Cash Price |
$4,558.05
|
| Rate for Payer: Cash Price |
$4,558.05
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,090.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,051.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,051.60
|
| Rate for Payer: Galaxy Health WC |
$8,609.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,077.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,431.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,976.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,430.96
|
| Rate for Payer: Multiplan Commercial |
$8,103.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,609.65
|
|
|
HC ROOM TRAUMA ICU
|
Facility
|
IP
|
$27,889.00
|
|
| Hospital Charge Code |
902314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,705.65 |
| Rate for Payer: Adventist Health Commercial |
$5,577.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Cash Price |
$12,550.05
|
| Rate for Payer: Cash Price |
$12,550.05
|
| Rate for Payer: Cash Price |
$12,550.05
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,522.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,155.60
|
| Rate for Payer: Galaxy Health WC |
$23,705.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,733.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,709.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,454.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,693.36
|
| Rate for Payer: Multiplan Commercial |
$22,311.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,705.65
|
|
|
HC ROOM TRAUMA ICU 1:1
|
Facility
|
IP
|
$27,077.00
|
|
| Hospital Charge Code |
992314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,015.45 |
| Rate for Payer: Adventist Health Commercial |
$5,415.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Cash Price |
$12,184.65
|
| Rate for Payer: Cash Price |
$12,184.65
|
| Rate for Payer: Cash Price |
$12,184.65
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,953.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,830.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,830.80
|
| Rate for Payer: Galaxy Health WC |
$23,015.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16,246.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,193.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,975.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,498.48
|
| Rate for Payer: Multiplan Commercial |
$21,661.60
|
| Rate for Payer: Prime Health Services Commercial |
$23,015.45
|
|
|
HC ROOM TRAUMA ICU ISOLATION
|
Facility
|
IP
|
$26,391.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$22,432.35 |
| Rate for Payer: Adventist Health Commercial |
$5,278.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Cash Price |
$11,875.95
|
| Rate for Payer: Cash Price |
$11,875.95
|
| Rate for Payer: Cash Price |
$11,875.95
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,473.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,556.40
|
| Rate for Payer: Galaxy Health WC |
$22,432.35
|
| Rate for Payer: Global Benefits Group Commercial |
$15,834.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,758.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,570.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,333.84
|
| Rate for Payer: Multiplan Commercial |
$21,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,432.35
|
|
|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
|
IP
|
$25,623.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$21,779.55 |
| Rate for Payer: Adventist Health Commercial |
$5,124.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Cash Price |
$11,530.35
|
| Rate for Payer: Cash Price |
$11,530.35
|
| Rate for Payer: Cash Price |
$11,530.35
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,936.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,249.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,249.20
|
| Rate for Payer: Galaxy Health WC |
$21,779.55
|
| Rate for Payer: Global Benefits Group Commercial |
$15,373.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,270.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,117.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,149.52
|
| Rate for Payer: Multiplan Commercial |
$20,498.40
|
| Rate for Payer: Prime Health Services Commercial |
$21,779.55
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,870.85 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,332.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,115.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,692.57
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$798.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.70
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.24
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.31
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cigna of CA HMO |
$342.40
|
| Rate for Payer: Cigna of CA PPO |
$395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$454.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$374.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$339.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$374.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$374.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$339.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$982.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$891.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$828.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$2,857.84 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,857.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$772.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,053.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$900.95
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna of CA HMO |
$898.56
|
| Rate for Payer: Cigna of CA PPO |
$1,038.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,193.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,193.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$982.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$891.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$509.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$828.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$982.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$982.80
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$842.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$702.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$702.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,193.40
|
|
|
HC ROTOVIRUS AG
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC ROTOVIRUS AG
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$17.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.88
|
| Rate for Payer: Blue Shield of California Commercial |
$27.18
|
| Rate for Payer: Blue Shield of California Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.73
|
| Rate for Payer: Blue Shield of California Commercial |
$308.37
|
| Rate for Payer: Blue Shield of California Commercial |
$203.31
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
