|
HC TRAUMA ACTIVATION LEVEL B
|
Facility
|
IP
|
$38,814.00
|
|
| Hospital Charge Code |
904300101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$7,762.80 |
| Max. Negotiated Rate |
$34,932.60 |
| Rate for Payer: Adventist Health Commercial |
$7,762.80
|
| Rate for Payer: Cash Price |
$17,466.30
|
| Rate for Payer: Central Health Plan Commercial |
$31,051.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,169.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,525.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Management Network EPO/PPO |
$34,932.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,646.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,900.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,762.80
|
| Rate for Payer: Multiplan Commercial |
$29,110.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,991.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,034.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17,497.35
|
| Rate for Payer: United Healthcare HMO Rider |
$16,798.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,389.75
|
|
|
HC TRAUMA ACTIVATION LEVEL B
|
Facility
|
OP
|
$38,814.00
|
|
| Hospital Charge Code |
904300101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$7,762.80 |
| Max. Negotiated Rate |
$34,932.60 |
| Rate for Payer: Adventist Health Commercial |
$7,762.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29,444.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,991.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,347.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,110.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24,608.08
|
| Rate for Payer: Blue Shield of California EPN |
$15,486.79
|
| Rate for Payer: Cash Price |
$17,466.30
|
| Rate for Payer: Cash Price |
$17,466.30
|
| Rate for Payer: Central Health Plan Commercial |
$31,051.20
|
| 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 Medi-Cal |
$32,991.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,991.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,169.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,525.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Management Network EPO/PPO |
$34,932.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,646.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,089.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,900.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,762.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,169.80
|
| Rate for Payer: Multiplan Commercial |
$29,110.50
|
| Rate for Payer: Networks By Design Commercial |
$25,229.10
|
| Rate for Payer: Prime Health Services Commercial |
$32,991.90
|
| Rate for Payer: Riverside University Health System MISP |
$15,525.60
|
| 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 |
$19,034.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17,497.35
|
| Rate for Payer: United Healthcare HMO Rider |
$16,798.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,389.75
|
| 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
|
IP
|
$17,142.00
|
|
| Hospital Charge Code |
904300102
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,428.40 |
| Max. Negotiated Rate |
$15,427.80 |
| Rate for Payer: Adventist Health Commercial |
$3,428.40
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,713.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,999.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,856.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Management Network EPO/PPO |
$15,427.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,885.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,113.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,428.40
|
| Rate for Payer: Multiplan Commercial |
$12,856.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,570.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,406.44
|
| Rate for Payer: United Healthcare All Other HMO |
$7,727.61
|
| Rate for Payer: United Healthcare HMO Rider |
$7,419.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,796.80
|
|
|
HC TRAUMA ACTIVATION LEVEL C
|
Facility
|
OP
|
$17,142.00
|
|
| Hospital Charge Code |
904300102
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,428.40 |
| Max. Negotiated Rate |
$15,427.80 |
| Rate for Payer: Adventist Health Commercial |
$3,428.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,003.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,570.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,428.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,856.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,868.03
|
| Rate for Payer: Blue Shield of California EPN |
$6,839.66
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,713.60
|
| 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 Medi-Cal |
$14,570.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,570.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,999.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,856.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Management Network EPO/PPO |
$15,427.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,885.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,222.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,113.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,428.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,999.40
|
| Rate for Payer: Multiplan Commercial |
$12,856.50
|
| Rate for Payer: Networks By Design Commercial |
$11,142.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,570.70
|
| Rate for Payer: Riverside University Health System MISP |
$6,856.80
|
| 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 |
$8,406.44
|
| Rate for Payer: United Healthcare All Other HMO |
$7,727.61
|
| Rate for Payer: United Healthcare HMO Rider |
$7,419.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,796.80
|
| 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 TRAUMACATH VENTRCULR SET 1.9MM
|
Facility
|
OP
|
$603.66
|
|
| Hospital Charge Code |
901698858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.73 |
| Max. Negotiated Rate |
$543.29 |
| Rate for Payer: Adventist Health Commercial |
$120.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$366.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$513.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$452.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$292.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.15
|
| Rate for Payer: Blue Shield of California Commercial |
$382.72
|
| Rate for Payer: Blue Shield of California EPN |
$240.86
|
| Rate for Payer: Cash Price |
$271.65
|
| Rate for Payer: Central Health Plan Commercial |
$482.93
|
| Rate for Payer: Cigna of CA HMO |
$386.34
|
| Rate for Payer: Cigna of CA PPO |
$446.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$513.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$513.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$513.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.46
|
| Rate for Payer: EPIC Health Plan Senior |
$241.46
|
| Rate for Payer: Galaxy Health WC |
$513.11
|
| Rate for Payer: Global Benefits Group Commercial |
$362.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$543.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$383.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$422.56
|
| Rate for Payer: Multiplan Commercial |
$452.75
|
| Rate for Payer: Networks By Design Commercial |
$392.38
|
| Rate for Payer: Prime Health Services Commercial |
$513.11
|
| Rate for Payer: Riverside University Health System MISP |
$241.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$362.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$362.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$301.83
|
| Rate for Payer: United Healthcare All Other HMO |
$301.83
|
| Rate for Payer: United Healthcare HMO Rider |
$301.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$301.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$513.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$513.11
|
| Rate for Payer: Vantage Medical Group Senior |
$513.11
|
|
|
HC TRAUMACATH VENTRCULR SET 1.9MM
|
Facility
|
IP
|
$603.66
|
|
| Hospital Charge Code |
901698858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.73 |
| Max. Negotiated Rate |
$543.29 |
| Rate for Payer: Adventist Health Commercial |
$120.73
|
| Rate for Payer: Cash Price |
$271.65
|
| Rate for Payer: Central Health Plan Commercial |
$482.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$422.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.46
|
| Rate for Payer: EPIC Health Plan Senior |
$241.46
|
| Rate for Payer: Galaxy Health WC |
$513.11
|
| Rate for Payer: Global Benefits Group Commercial |
$362.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$543.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$383.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.73
|
| Rate for Payer: Multiplan Commercial |
$452.75
|
| Rate for Payer: Networks By Design Commercial |
$392.38
|
| Rate for Payer: Prime Health Services Commercial |
$513.11
|
|
|
HC TRAY CATH 14FR URN MTR/DRAIN
|
Facility
|
OP
|
$99.94
|
|
| Hospital Charge Code |
901698935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Adventist Health Commercial |
$19.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.14
|
| Rate for Payer: Blue Shield of California Commercial |
$63.36
|
| Rate for Payer: Blue Shield of California EPN |
$39.88
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Cigna of CA HMO |
$63.96
|
| Rate for Payer: Cigna of CA PPO |
$73.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$69.96
|
| Rate for Payer: Multiplan Commercial |
$74.95
|
| Rate for Payer: Networks By Design Commercial |
$64.96
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
| Rate for Payer: Riverside University Health System MISP |
$39.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.97
|
| Rate for Payer: United Healthcare All Other HMO |
$49.97
|
| Rate for Payer: United Healthcare HMO Rider |
$49.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.95
|
| Rate for Payer: Vantage Medical Group Senior |
$84.95
|
|
|
HC TRAY CATH 14FR URN MTR/DRAIN
|
Facility
|
IP
|
$99.94
|
|
| Hospital Charge Code |
901698935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Adventist Health Commercial |
$19.99
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Central Health Plan Commercial |
$79.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.98
|
| Rate for Payer: EPIC Health Plan Senior |
$39.98
|
| Rate for Payer: Galaxy Health WC |
$84.95
|
| Rate for Payer: Global Benefits Group Commercial |
$59.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.99
|
| Rate for Payer: Multiplan Commercial |
$74.95
|
| Rate for Payer: Networks By Design Commercial |
$64.96
|
| Rate for Payer: Prime Health Services Commercial |
$84.95
|
|
|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
|
OP
|
$162.12
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$145.91 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.31
|
| Rate for Payer: Blue Shield of California Commercial |
$102.78
|
| Rate for Payer: Blue Shield of California EPN |
$64.69
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| Rate for Payer: Cigna of CA HMO |
$103.76
|
| Rate for Payer: Cigna of CA PPO |
$119.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.48
|
| Rate for Payer: Multiplan Commercial |
$121.59
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
| Rate for Payer: Riverside University Health System MISP |
$64.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.06
|
| Rate for Payer: United Healthcare All Other HMO |
$81.06
|
| Rate for Payer: United Healthcare HMO Rider |
$81.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.80
|
| Rate for Payer: Vantage Medical Group Senior |
$137.80
|
|
|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
|
IP
|
$162.12
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$145.91 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Multiplan Commercial |
$121.59
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
|
IP
|
$105.49
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$94.94 |
| Rate for Payer: Adventist Health Commercial |
$21.10
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Central Health Plan Commercial |
$84.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.20
|
| Rate for Payer: EPIC Health Plan Senior |
$42.20
|
| Rate for Payer: Galaxy Health WC |
$89.67
|
| Rate for Payer: Global Benefits Group Commercial |
$63.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.10
|
| Rate for Payer: Multiplan Commercial |
$79.12
|
| Rate for Payer: Networks By Design Commercial |
$68.57
|
| Rate for Payer: Prime Health Services Commercial |
$89.67
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
|
OP
|
$105.49
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$94.94 |
| Rate for Payer: Adventist Health Commercial |
$21.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.36
|
| Rate for Payer: Blue Shield of California Commercial |
$66.88
|
| Rate for Payer: Blue Shield of California EPN |
$42.09
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Central Health Plan Commercial |
$84.39
|
| Rate for Payer: Cigna of CA HMO |
$67.51
|
| Rate for Payer: Cigna of CA PPO |
$78.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.20
|
| Rate for Payer: EPIC Health Plan Senior |
$42.20
|
| Rate for Payer: Galaxy Health WC |
$89.67
|
| Rate for Payer: Global Benefits Group Commercial |
$63.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.84
|
| Rate for Payer: Multiplan Commercial |
$79.12
|
| Rate for Payer: Networks By Design Commercial |
$68.57
|
| Rate for Payer: Prime Health Services Commercial |
$89.67
|
| Rate for Payer: Riverside University Health System MISP |
$42.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.74
|
| Rate for Payer: United Healthcare All Other HMO |
$52.74
|
| Rate for Payer: United Healthcare HMO Rider |
$52.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.67
|
| Rate for Payer: Vantage Medical Group Senior |
$89.67
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
|
IP
|
$125.86
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$113.27 |
| Rate for Payer: Adventist Health Commercial |
$25.17
|
| Rate for Payer: Cash Price |
$56.64
|
| Rate for Payer: Central Health Plan Commercial |
$100.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.34
|
| Rate for Payer: EPIC Health Plan Senior |
$50.34
|
| Rate for Payer: Galaxy Health WC |
$106.98
|
| Rate for Payer: Global Benefits Group Commercial |
$75.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.17
|
| Rate for Payer: Multiplan Commercial |
$94.39
|
| Rate for Payer: Networks By Design Commercial |
$81.81
|
| Rate for Payer: Prime Health Services Commercial |
$106.98
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
|
OP
|
$125.86
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$113.27 |
| Rate for Payer: Adventist Health Commercial |
$25.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.21
|
| Rate for Payer: Blue Shield of California Commercial |
$79.80
|
| Rate for Payer: Blue Shield of California EPN |
$50.22
|
| Rate for Payer: Cash Price |
$56.64
|
| Rate for Payer: Cash Price |
$56.64
|
| Rate for Payer: Central Health Plan Commercial |
$100.69
|
| Rate for Payer: Cigna of CA HMO |
$80.55
|
| Rate for Payer: Cigna of CA PPO |
$93.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.34
|
| Rate for Payer: EPIC Health Plan Senior |
$50.34
|
| Rate for Payer: Galaxy Health WC |
$106.98
|
| Rate for Payer: Global Benefits Group Commercial |
$75.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$88.10
|
| Rate for Payer: Multiplan Commercial |
$94.39
|
| Rate for Payer: Networks By Design Commercial |
$81.81
|
| Rate for Payer: Prime Health Services Commercial |
$106.98
|
| Rate for Payer: Riverside University Health System MISP |
$50.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.93
|
| Rate for Payer: United Healthcare All Other HMO |
$62.93
|
| Rate for Payer: United Healthcare HMO Rider |
$62.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.98
|
| Rate for Payer: Vantage Medical Group Senior |
$106.98
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
|
IP
|
$105.56
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Adventist Health Commercial |
$21.11
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Central Health Plan Commercial |
$84.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.22
|
| Rate for Payer: EPIC Health Plan Senior |
$42.22
|
| Rate for Payer: Galaxy Health WC |
$89.73
|
| Rate for Payer: Global Benefits Group Commercial |
$63.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.11
|
| Rate for Payer: Multiplan Commercial |
$79.17
|
| Rate for Payer: Networks By Design Commercial |
$68.61
|
| Rate for Payer: Prime Health Services Commercial |
$89.73
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
|
OP
|
$105.56
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Adventist Health Commercial |
$21.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.40
|
| Rate for Payer: Blue Shield of California Commercial |
$66.93
|
| Rate for Payer: Blue Shield of California EPN |
$42.12
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Central Health Plan Commercial |
$84.45
|
| Rate for Payer: Cigna of CA HMO |
$67.56
|
| Rate for Payer: Cigna of CA PPO |
$78.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.22
|
| Rate for Payer: EPIC Health Plan Senior |
$42.22
|
| Rate for Payer: Galaxy Health WC |
$89.73
|
| Rate for Payer: Global Benefits Group Commercial |
$63.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.89
|
| Rate for Payer: Multiplan Commercial |
$79.17
|
| Rate for Payer: Networks By Design Commercial |
$68.61
|
| Rate for Payer: Prime Health Services Commercial |
$89.73
|
| Rate for Payer: Riverside University Health System MISP |
$42.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.78
|
| Rate for Payer: United Healthcare All Other HMO |
$52.78
|
| Rate for Payer: United Healthcare HMO Rider |
$52.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.73
|
| Rate for Payer: Vantage Medical Group Senior |
$89.73
|
|
|
HC TRAY CATH COUDE URN MTR 16FR
|
Facility
|
IP
|
$153.37
|
|
| Hospital Charge Code |
901608086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$138.03 |
| Rate for Payer: Adventist Health Commercial |
$30.67
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Central Health Plan Commercial |
$122.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.35
|
| Rate for Payer: EPIC Health Plan Senior |
$61.35
|
| Rate for Payer: Galaxy Health WC |
$130.36
|
| Rate for Payer: Global Benefits Group Commercial |
$92.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.67
|
| Rate for Payer: Multiplan Commercial |
$115.03
|
| Rate for Payer: Networks By Design Commercial |
$99.69
|
| Rate for Payer: Prime Health Services Commercial |
$130.36
|
|
|
HC TRAY CATH COUDE URN MTR 16FR
|
Facility
|
OP
|
$153.37
|
|
| Hospital Charge Code |
901608086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$138.03 |
| Rate for Payer: Adventist Health Commercial |
$30.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.22
|
| Rate for Payer: Blue Shield of California Commercial |
$97.24
|
| Rate for Payer: Blue Shield of California EPN |
$61.19
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Central Health Plan Commercial |
$122.70
|
| Rate for Payer: Cigna of CA HMO |
$98.16
|
| Rate for Payer: Cigna of CA PPO |
$113.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.35
|
| Rate for Payer: EPIC Health Plan Senior |
$61.35
|
| Rate for Payer: Galaxy Health WC |
$130.36
|
| Rate for Payer: Global Benefits Group Commercial |
$92.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$107.36
|
| Rate for Payer: Multiplan Commercial |
$115.03
|
| Rate for Payer: Networks By Design Commercial |
$99.69
|
| Rate for Payer: Prime Health Services Commercial |
$130.36
|
| Rate for Payer: Riverside University Health System MISP |
$61.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.69
|
| Rate for Payer: United Healthcare All Other HMO |
$76.69
|
| Rate for Payer: United Healthcare HMO Rider |
$76.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.36
|
| Rate for Payer: Vantage Medical Group Senior |
$130.36
|
|
|
HC TRAY CATH PICC POWER 3FR SL
|
Facility
|
OP
|
$906.38
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901606420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.28 |
| Max. Negotiated Rate |
$815.74 |
| Rate for Payer: Adventist Health Commercial |
$181.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$770.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$498.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$679.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$413.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$497.06
|
| Rate for Payer: Blue Shield of California Commercial |
$726.92
|
| Rate for Payer: Blue Shield of California EPN |
$456.82
|
| Rate for Payer: Cash Price |
$407.87
|
| Rate for Payer: Central Health Plan Commercial |
$725.10
|
| Rate for Payer: Cigna of CA HMO |
$634.47
|
| Rate for Payer: Cigna of CA PPO |
$634.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$770.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$634.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.55
|
| Rate for Payer: EPIC Health Plan Senior |
$362.55
|
| Rate for Payer: Galaxy Health WC |
$770.42
|
| Rate for Payer: Global Benefits Group Commercial |
$543.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$815.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$575.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$329.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$634.47
|
| Rate for Payer: Multiplan Commercial |
$679.78
|
| Rate for Payer: Networks By Design Commercial |
$453.19
|
| Rate for Payer: Prime Health Services Commercial |
$770.42
|
| Rate for Payer: Riverside University Health System MISP |
$362.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$543.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.16
|
| Rate for Payer: United Healthcare All Other HMO |
$331.10
|
| Rate for Payer: United Healthcare HMO Rider |
$323.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$770.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.42
|
| Rate for Payer: Vantage Medical Group Senior |
$770.42
|
|
|
HC TRAY CATH PICC POWER 3FR SL
|
Facility
|
IP
|
$906.38
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901606420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.28 |
| Max. Negotiated Rate |
$815.74 |
| Rate for Payer: Adventist Health Commercial |
$181.28
|
| Rate for Payer: Blue Shield of California Commercial |
$726.92
|
| Rate for Payer: Blue Shield of California EPN |
$456.82
|
| Rate for Payer: Cash Price |
$407.87
|
| Rate for Payer: Central Health Plan Commercial |
$725.10
|
| Rate for Payer: Cigna of CA HMO |
$634.47
|
| Rate for Payer: Cigna of CA PPO |
$634.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$634.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.55
|
| Rate for Payer: EPIC Health Plan Senior |
$362.55
|
| Rate for Payer: Galaxy Health WC |
$770.42
|
| Rate for Payer: Global Benefits Group Commercial |
$543.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$815.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$575.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.28
|
| Rate for Payer: Multiplan Commercial |
$679.78
|
| Rate for Payer: Networks By Design Commercial |
$453.19
|
| Rate for Payer: Prime Health Services Commercial |
$770.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.16
|
| Rate for Payer: United Healthcare All Other HMO |
$331.10
|
| Rate for Payer: United Healthcare HMO Rider |
$323.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.84
|
|
|
HC TRAY CATH PIGTAIL FUHRMAN 8.5FR
|
Facility
|
IP
|
$823.54
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901606896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.71 |
| Max. Negotiated Rate |
$741.19 |
| Rate for Payer: Adventist Health Commercial |
$164.71
|
| Rate for Payer: Cash Price |
$370.59
|
| Rate for Payer: Central Health Plan Commercial |
$658.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$576.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.42
|
| Rate for Payer: EPIC Health Plan Senior |
$329.42
|
| Rate for Payer: Galaxy Health WC |
$700.01
|
| Rate for Payer: Global Benefits Group Commercial |
$494.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$741.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$522.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$485.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.71
|
| Rate for Payer: Multiplan Commercial |
$617.65
|
| Rate for Payer: Networks By Design Commercial |
$535.30
|
| Rate for Payer: Prime Health Services Commercial |
$700.01
|
|
|
HC TRAY CATH PIGTAIL FUHRMAN 8.5FR
|
Facility
|
OP
|
$823.54
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901606896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.71 |
| Max. Negotiated Rate |
$741.19 |
| Rate for Payer: Adventist Health Commercial |
$164.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$700.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$452.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$617.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$398.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$479.05
|
| Rate for Payer: Blue Shield of California Commercial |
$522.12
|
| Rate for Payer: Blue Shield of California EPN |
$328.59
|
| Rate for Payer: Cash Price |
$370.59
|
| Rate for Payer: Cash Price |
$370.59
|
| Rate for Payer: Central Health Plan Commercial |
$658.83
|
| Rate for Payer: Cigna of CA HMO |
$527.07
|
| Rate for Payer: Cigna of CA PPO |
$609.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$700.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$700.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$700.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$576.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.42
|
| Rate for Payer: EPIC Health Plan Senior |
$329.42
|
| Rate for Payer: Galaxy Health WC |
$700.01
|
| Rate for Payer: Global Benefits Group Commercial |
$494.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$741.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$522.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$485.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$576.48
|
| Rate for Payer: Multiplan Commercial |
$617.65
|
| Rate for Payer: Networks By Design Commercial |
$535.30
|
| Rate for Payer: Prime Health Services Commercial |
$700.01
|
| Rate for Payer: Riverside University Health System MISP |
$329.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$494.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$494.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$411.77
|
| Rate for Payer: United Healthcare All Other HMO |
$411.77
|
| Rate for Payer: United Healthcare HMO Rider |
$411.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$411.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$700.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$700.01
|
| Rate for Payer: Vantage Medical Group Senior |
$700.01
|
|
|
HC TRAY CATH PIGTAIL WAYNE 14FR
|
Facility
|
OP
|
$1,175.90
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901607301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.18 |
| Max. Negotiated Rate |
$1,058.31 |
| Rate for Payer: Adventist Health Commercial |
$235.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$999.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$646.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$536.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$644.86
|
| Rate for Payer: Blue Shield of California Commercial |
$943.07
|
| Rate for Payer: Blue Shield of California EPN |
$592.65
|
| Rate for Payer: Cash Price |
$529.16
|
| Rate for Payer: Central Health Plan Commercial |
$940.72
|
| Rate for Payer: Cigna of CA HMO |
$823.13
|
| Rate for Payer: Cigna of CA PPO |
$823.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$999.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$999.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$999.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$823.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.36
|
| Rate for Payer: EPIC Health Plan Senior |
$470.36
|
| Rate for Payer: Galaxy Health WC |
$999.51
|
| Rate for Payer: Global Benefits Group Commercial |
$705.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,058.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$746.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$426.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$693.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$823.13
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Networks By Design Commercial |
$587.95
|
| Rate for Payer: Prime Health Services Commercial |
$999.51
|
| Rate for Payer: Riverside University Health System MISP |
$470.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$705.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$705.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.32
|
| Rate for Payer: United Healthcare All Other HMO |
$429.56
|
| Rate for Payer: United Healthcare HMO Rider |
$420.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$999.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$999.51
|
| Rate for Payer: Vantage Medical Group Senior |
$999.51
|
|
|
HC TRAY CATH PIGTAIL WAYNE 14FR
|
Facility
|
IP
|
$1,175.90
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901607301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.18 |
| Max. Negotiated Rate |
$1,058.31 |
| Rate for Payer: Adventist Health Commercial |
$235.18
|
| Rate for Payer: Blue Shield of California Commercial |
$943.07
|
| Rate for Payer: Blue Shield of California EPN |
$592.65
|
| Rate for Payer: Cash Price |
$529.16
|
| Rate for Payer: Central Health Plan Commercial |
$940.72
|
| Rate for Payer: Cigna of CA HMO |
$823.13
|
| Rate for Payer: Cigna of CA PPO |
$823.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$823.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.36
|
| Rate for Payer: EPIC Health Plan Senior |
$470.36
|
| Rate for Payer: Galaxy Health WC |
$999.51
|
| Rate for Payer: Global Benefits Group Commercial |
$705.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,058.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$746.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$693.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.18
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Networks By Design Commercial |
$587.95
|
| Rate for Payer: Prime Health Services Commercial |
$999.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.32
|
| Rate for Payer: United Healthcare All Other HMO |
$429.56
|
| Rate for Payer: United Healthcare HMO Rider |
$420.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.11
|
|
|
HC TRAY CATH SLCN 16FR URN MTR
|
Facility
|
IP
|
$195.86
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.17 |
| Max. Negotiated Rate |
$176.27 |
| Rate for Payer: Adventist Health Commercial |
$39.17
|
| Rate for Payer: Cash Price |
$88.14
|
| Rate for Payer: Central Health Plan Commercial |
$156.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.34
|
| Rate for Payer: EPIC Health Plan Senior |
$78.34
|
| Rate for Payer: Galaxy Health WC |
$166.48
|
| Rate for Payer: Global Benefits Group Commercial |
$117.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.17
|
| Rate for Payer: Multiplan Commercial |
$146.90
|
| Rate for Payer: Networks By Design Commercial |
$127.31
|
| Rate for Payer: Prime Health Services Commercial |
$166.48
|
|
