|
HC TRAUMA ACTIVATION LEVEL A
|
Facility
IP
|
$65,249.00
|
|
| Hospital Charge Code |
904300100
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$13,049.80 |
| Max. Negotiated Rate |
$58,724.10 |
| Rate for Payer: Cash Price |
$29,362.05
|
| Rate for Payer: Central Health Plan Commercial |
$52,199.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,099.60
|
| Rate for Payer: Galaxy Health WC |
$55,461.65
|
| Rate for Payer: Global Benefits Group Commercial |
$39,149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$58,724.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43,521.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,049.80
|
| Rate for Payer: Multiplan Commercial |
$48,936.75
|
| Rate for Payer: Prime Health Services Commercial |
$55,461.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,193.86
|
| Rate for Payer: United Healthcare All Other HMO |
$29,694.82
|
| Rate for Payer: United Healthcare HMO Rider |
$28,507.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26,066.98
|
|
|
HC TRAUMA ACTIVATION LEVEL A
|
Facility
OP
|
$65,249.00
|
|
| Hospital Charge Code |
904300100
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$7,785.00 |
| Max. Negotiated Rate |
$58,724.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,497.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55,461.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35,886.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35,886.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,006.00
|
| Rate for Payer: BCBS Transplant Transplant |
$39,149.40
|
| Rate for Payer: Blue Shield of California Commercial |
$41,041.62
|
| Rate for Payer: Blue Shield of California EPN |
$31,906.76
|
| Rate for Payer: Cash Price |
$29,362.05
|
| Rate for Payer: Cash Price |
$29,362.05
|
| Rate for Payer: Central Health Plan Commercial |
$52,199.20
|
| Rate for Payer: Cigna of CA PPO |
$48,284.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55,461.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,099.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$26,099.60
|
| Rate for Payer: Galaxy Health WC |
$55,461.65
|
| Rate for Payer: Global Benefits Group Commercial |
$39,149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$58,724.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48,936.75
|
| Rate for Payer: IEHP medi-cal |
$22,837.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43,521.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,049.80
|
| Rate for Payer: Multiplan Commercial |
$48,936.75
|
| Rate for Payer: Networks By Design Commercial |
$55,461.65
|
| Rate for Payer: Prime Health Services Commercial |
$55,461.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$39,149.40
|
| Rate for Payer: Riverside University Health MISP |
$26,099.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39,149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39,149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,193.86
|
| Rate for Payer: United Healthcare All Other HMO |
$29,694.82
|
| Rate for Payer: United Healthcare HMO Rider |
$28,507.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26,066.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55,461.65
|
| Rate for Payer: Vantage Medical Group Senior |
$55,461.65
|
|
|
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: Aetna of CA HMO/PPO |
$29,444.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,991.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21,347.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,347.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,006.00
|
| Rate for Payer: BCBS Transplant Transplant |
$23,288.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24,414.01
|
| Rate for Payer: Blue Shield of California EPN |
$18,980.05
|
| 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: EPIC Health Plan Commercial |
$15,525.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15,525.60
|
| Rate for Payer: Galaxy Health WC |
$32,991.90
|
| Rate for Payer: Global Benefits Group Commercial |
$23,288.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,932.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29,110.50
|
| Rate for Payer: IEHP medi-cal |
$13,584.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,888.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,762.80
|
| Rate for Payer: Multiplan Commercial |
$29,110.50
|
| Rate for Payer: Networks By Design Commercial |
$32,991.90
|
| Rate for Payer: Prime Health Services Commercial |
$32,991.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23,288.40
|
| Rate for Payer: Riverside University Health 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 |
$19,150.83
|
| Rate for Payer: United Healthcare All Other HMO |
$17,664.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16,957.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,506.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,991.90
|
| Rate for Payer: Vantage Medical Group Senior |
$32,991.90
|
|
|
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: Cash Price |
$17,466.30
|
| Rate for Payer: Central Health Plan Commercial |
$31,051.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,525.60
|
| Rate for Payer: Galaxy Health WC |
$32,991.90
|
| Rate for Payer: Global Benefits Group Commercial |
$23,288.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,932.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,888.94
|
| 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 |
$19,150.83
|
| Rate for Payer: United Healthcare All Other HMO |
$17,664.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16,957.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,506.19
|
|
|
HC TRAUMA ACTIVATION LEVEL 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: Cash Price |
$7,713.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,713.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,856.80
|
| Rate for Payer: Galaxy Health WC |
$14,570.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,285.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,427.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,433.71
|
| 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 |
$8,457.86
|
| Rate for Payer: United Healthcare All Other HMO |
$7,801.32
|
| Rate for Payer: United Healthcare HMO Rider |
$7,489.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,848.23
|
|
|
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: Aetna of CA HMO/PPO |
$13,003.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,570.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,428.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,428.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,006.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,285.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,782.32
|
| Rate for Payer: Blue Shield of California EPN |
$8,382.44
|
| 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: EPIC Health Plan Commercial |
$6,856.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,856.80
|
| Rate for Payer: Galaxy Health WC |
$14,570.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,285.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,427.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,856.50
|
| Rate for Payer: IEHP medi-cal |
$5,999.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,433.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,428.40
|
| Rate for Payer: Multiplan Commercial |
$12,856.50
|
| Rate for Payer: Networks By Design Commercial |
$14,570.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,570.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,285.20
|
| Rate for Payer: Riverside University Health 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 |
$8,457.86
|
| Rate for Payer: United Healthcare All Other HMO |
$7,801.32
|
| Rate for Payer: United Healthcare HMO Rider |
$7,489.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,848.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,570.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14,570.70
|
|
|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
IP
|
$159.46
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$143.51 |
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Central Health Plan Commercial |
$127.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.78
|
| Rate for Payer: Galaxy Health WC |
$135.54
|
| Rate for Payer: Global Benefits Group Commercial |
$95.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.89
|
| Rate for Payer: Multiplan Commercial |
$119.60
|
| Rate for Payer: Networks By Design Commercial |
$103.65
|
| Rate for Payer: Prime Health Services Commercial |
$135.54
|
|
|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
OP
|
$159.46
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$143.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$83.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$135.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$87.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$87.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.21
|
| Rate for Payer: BCBS Transplant Transplant |
$95.68
|
| Rate for Payer: Blue Shield of California Commercial |
$100.30
|
| Rate for Payer: Blue Shield of California EPN |
$77.98
|
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Central Health Plan Commercial |
$127.57
|
| Rate for Payer: Cigna of CA HMO |
$102.05
|
| Rate for Payer: Cigna of CA PPO |
$118.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.78
|
| Rate for Payer: Galaxy Health WC |
$135.54
|
| Rate for Payer: Global Benefits Group Commercial |
$95.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$119.60
|
| Rate for Payer: IEHP medi-cal |
$55.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.89
|
| Rate for Payer: Multiplan Commercial |
$119.60
|
| Rate for Payer: Networks By Design Commercial |
$103.65
|
| Rate for Payer: Prime Health Services Commercial |
$135.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$95.68
|
| Rate for Payer: Riverside University Health MISP |
$63.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.73
|
| Rate for Payer: United Healthcare All Other HMO |
$79.73
|
| Rate for Payer: United Healthcare HMO Rider |
$79.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$135.54
|
| Rate for Payer: Vantage Medical Group Senior |
$135.54
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
IP
|
$98.27
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$88.44 |
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Central Health Plan Commercial |
$78.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.53
|
| Rate for Payer: Global Benefits Group Commercial |
$58.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.65
|
| Rate for Payer: Multiplan Commercial |
$73.70
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.53
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
OP
|
$98.27
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$88.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$83.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$54.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.06
|
| Rate for Payer: BCBS Transplant Transplant |
$58.96
|
| Rate for Payer: Blue Shield of California Commercial |
$61.81
|
| Rate for Payer: Blue Shield of California EPN |
$48.05
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Central Health Plan Commercial |
$78.62
|
| Rate for Payer: Cigna of CA HMO |
$62.89
|
| Rate for Payer: Cigna of CA PPO |
$72.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.53
|
| Rate for Payer: Global Benefits Group Commercial |
$58.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$73.70
|
| Rate for Payer: IEHP medi-cal |
$34.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.65
|
| Rate for Payer: Multiplan Commercial |
$73.70
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$58.96
|
| Rate for Payer: Riverside University Health MISP |
$39.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.14
|
| Rate for Payer: United Healthcare All Other HMO |
$49.14
|
| Rate for Payer: United Healthcare HMO Rider |
$49.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.53
|
| Rate for Payer: Vantage Medical Group Senior |
$83.53
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
IP
|
$117.12
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$105.41 |
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Central Health Plan Commercial |
$93.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.85
|
| Rate for Payer: Galaxy Health WC |
$99.55
|
| Rate for Payer: Global Benefits Group Commercial |
$70.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Multiplan Commercial |
$87.84
|
| Rate for Payer: Networks By Design Commercial |
$76.13
|
| Rate for Payer: Prime Health Services Commercial |
$99.55
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
OP
|
$117.12
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$105.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$99.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.19
|
| Rate for Payer: BCBS Transplant Transplant |
$70.27
|
| Rate for Payer: Blue Shield of California Commercial |
$73.67
|
| Rate for Payer: Blue Shield of California EPN |
$57.27
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Central Health Plan Commercial |
$93.70
|
| Rate for Payer: Cigna of CA HMO |
$74.96
|
| Rate for Payer: Cigna of CA PPO |
$86.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.85
|
| Rate for Payer: Galaxy Health WC |
$99.55
|
| Rate for Payer: Global Benefits Group Commercial |
$70.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$87.84
|
| Rate for Payer: IEHP medi-cal |
$40.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Multiplan Commercial |
$87.84
|
| Rate for Payer: Networks By Design Commercial |
$76.13
|
| Rate for Payer: Prime Health Services Commercial |
$99.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$70.27
|
| Rate for Payer: Riverside University Health MISP |
$46.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Other HMO |
$58.56
|
| Rate for Payer: United Healthcare HMO Rider |
$58.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Vantage Medical Group Senior |
$99.55
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
OP
|
$98.27
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$88.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$83.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$54.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.06
|
| Rate for Payer: BCBS Transplant Transplant |
$58.96
|
| Rate for Payer: Blue Shield of California Commercial |
$61.81
|
| Rate for Payer: Blue Shield of California EPN |
$48.05
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Central Health Plan Commercial |
$78.62
|
| Rate for Payer: Cigna of CA HMO |
$62.89
|
| Rate for Payer: Cigna of CA PPO |
$72.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.53
|
| Rate for Payer: Global Benefits Group Commercial |
$58.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$73.70
|
| Rate for Payer: IEHP medi-cal |
$34.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.65
|
| Rate for Payer: Multiplan Commercial |
$73.70
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$58.96
|
| Rate for Payer: Riverside University Health MISP |
$39.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.14
|
| Rate for Payer: United Healthcare All Other HMO |
$49.14
|
| Rate for Payer: United Healthcare HMO Rider |
$49.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.53
|
| Rate for Payer: Vantage Medical Group Senior |
$83.53
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
IP
|
$98.27
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$88.44 |
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Central Health Plan Commercial |
$78.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.53
|
| Rate for Payer: Global Benefits Group Commercial |
$58.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.65
|
| Rate for Payer: Multiplan Commercial |
$73.70
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.53
|
|
|
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: Cash Price |
$69.02
|
| Rate for Payer: Central Health Plan Commercial |
$122.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$102.30
|
| 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: Aetna of CA HMO/PPO |
$93.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$130.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.61
|
| Rate for Payer: BCBS Transplant Transplant |
$92.02
|
| Rate for Payer: Blue Shield of California Commercial |
$96.47
|
| Rate for Payer: Blue Shield of California EPN |
$75.00
|
| 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: EPIC Health Plan Commercial |
$61.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$115.03
|
| Rate for Payer: IEHP medi-cal |
$53.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.30
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$92.02
|
| Rate for Payer: Riverside University Health 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 |
$76.68
|
| Rate for Payer: United Healthcare All Other HMO |
$76.68
|
| Rate for Payer: United Healthcare HMO Rider |
$76.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.68
|
| 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 |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$770.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$498.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$413.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.85
|
| Rate for Payer: BCBS Transplant Transplant |
$543.83
|
| Rate for Payer: Blue Shield of California Commercial |
$679.78
|
| Rate for Payer: Blue Shield of California EPN |
$493.07
|
| Rate for Payer: Cash Price |
$407.87
|
| 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: EPIC Health Plan Commercial |
$362.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$679.78
|
| Rate for Payer: IEHP medi-cal |
$317.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.56
|
| 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: Riverside University Health 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 |
$453.19
|
| Rate for Payer: United Healthcare All Other HMO |
$453.19
|
| Rate for Payer: United Healthcare HMO Rider |
$453.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$453.19
|
| 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: Blue Shield of California EPN |
$484.01
|
| 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: EPIC Health Plan Commercial |
$362.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$604.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.28
|
| Rate for Payer: Multiplan Commercial |
$679.78
|
| Rate for Payer: Prime Health Services Commercial |
$770.42
|
|
|
HC TRAY CATH PIGTAIL FUHRMAN 8.5FR
|
Facility
IP
|
$797.23
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901606896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.45 |
| Max. Negotiated Rate |
$717.51 |
| Rate for Payer: Cash Price |
$358.75
|
| Rate for Payer: Central Health Plan Commercial |
$637.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.89
|
| Rate for Payer: Galaxy Health WC |
$677.65
|
| Rate for Payer: Global Benefits Group Commercial |
$478.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.45
|
| Rate for Payer: Multiplan Commercial |
$597.92
|
| Rate for Payer: Networks By Design Commercial |
$518.20
|
| Rate for Payer: Prime Health Services Commercial |
$677.65
|
|
|
HC TRAY CATH PIGTAIL FUHRMAN 8.5FR
|
Facility
OP
|
$797.23
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901606896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.45 |
| Max. Negotiated Rate |
$717.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$312.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$677.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$438.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$438.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$386.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$471.00
|
| Rate for Payer: BCBS Transplant Transplant |
$478.34
|
| Rate for Payer: Blue Shield of California Commercial |
$501.46
|
| Rate for Payer: Blue Shield of California EPN |
$389.85
|
| Rate for Payer: Cash Price |
$358.75
|
| Rate for Payer: Cash Price |
$358.75
|
| Rate for Payer: Central Health Plan Commercial |
$637.78
|
| Rate for Payer: Cigna of CA HMO |
$510.23
|
| Rate for Payer: Cigna of CA PPO |
$589.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$677.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.89
|
| Rate for Payer: Galaxy Health WC |
$677.65
|
| Rate for Payer: Global Benefits Group Commercial |
$478.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$597.92
|
| Rate for Payer: IEHP medi-cal |
$279.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.45
|
| Rate for Payer: Multiplan Commercial |
$597.92
|
| Rate for Payer: Networks By Design Commercial |
$518.20
|
| Rate for Payer: Prime Health Services Commercial |
$677.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$478.34
|
| Rate for Payer: Riverside University Health MISP |
$318.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$478.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$478.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.62
|
| Rate for Payer: United Healthcare All Other HMO |
$398.62
|
| Rate for Payer: United Healthcare HMO Rider |
$398.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$677.65
|
| Rate for Payer: Vantage Medical Group Senior |
$677.65
|
|
|
HC TRAY CATH PIGTAIL WAYNE 14FR
|
Facility
OP
|
$1,072.35
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901607301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.47 |
| Max. Negotiated Rate |
$965.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$312.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$911.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$589.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$589.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$489.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$597.30
|
| Rate for Payer: BCBS Transplant Transplant |
$643.41
|
| Rate for Payer: Blue Shield of California Commercial |
$804.26
|
| Rate for Payer: Blue Shield of California EPN |
$583.36
|
| Rate for Payer: Cash Price |
$482.56
|
| Rate for Payer: Cash Price |
$482.56
|
| Rate for Payer: Central Health Plan Commercial |
$857.88
|
| Rate for Payer: Cigna of CA HMO |
$750.64
|
| Rate for Payer: Cigna of CA PPO |
$750.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$911.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$428.94
|
| Rate for Payer: Galaxy Health WC |
$911.50
|
| Rate for Payer: Global Benefits Group Commercial |
$643.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$965.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$804.26
|
| Rate for Payer: IEHP medi-cal |
$375.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.47
|
| Rate for Payer: Multiplan Commercial |
$804.26
|
| Rate for Payer: Networks By Design Commercial |
$536.18
|
| Rate for Payer: Prime Health Services Commercial |
$911.50
|
| Rate for Payer: Riverside University Health MISP |
$428.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$643.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$643.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.18
|
| Rate for Payer: United Healthcare All Other HMO |
$536.18
|
| Rate for Payer: United Healthcare HMO Rider |
$536.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$536.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$911.50
|
| Rate for Payer: Vantage Medical Group Senior |
$911.50
|
|
|
HC TRAY CATH PIGTAIL WAYNE 14FR
|
Facility
IP
|
$1,072.35
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901607301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.47 |
| Max. Negotiated Rate |
$965.12 |
| Rate for Payer: Blue Shield of California EPN |
$572.63
|
| Rate for Payer: Cash Price |
$482.56
|
| Rate for Payer: Central Health Plan Commercial |
$857.88
|
| Rate for Payer: Cigna of CA HMO |
$750.64
|
| Rate for Payer: Cigna of CA PPO |
$750.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$428.94
|
| Rate for Payer: Galaxy Health WC |
$911.50
|
| Rate for Payer: Global Benefits Group Commercial |
$643.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$965.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.47
|
| Rate for Payer: Multiplan Commercial |
$804.26
|
| Rate for Payer: Prime Health Services Commercial |
$911.50
|
|
|
HC TRAY CATH SLCN 16FR URN MTR
|
Facility
IP
|
$182.21
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$163.99 |
| Rate for Payer: Cash Price |
$81.99
|
| Rate for Payer: Central Health Plan Commercial |
$145.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.88
|
| Rate for Payer: Galaxy Health WC |
$154.88
|
| Rate for Payer: Global Benefits Group Commercial |
$109.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.44
|
| Rate for Payer: Multiplan Commercial |
$136.66
|
| Rate for Payer: Networks By Design Commercial |
$118.44
|
| Rate for Payer: Prime Health Services Commercial |
$154.88
|
|
|
HC TRAY CATH SLCN 16FR URN MTR
|
Facility
OP
|
$182.21
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$163.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$154.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$100.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$100.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.65
|
| Rate for Payer: BCBS Transplant Transplant |
$109.33
|
| Rate for Payer: Blue Shield of California Commercial |
$114.61
|
| Rate for Payer: Blue Shield of California EPN |
$89.10
|
| Rate for Payer: Cash Price |
$81.99
|
| Rate for Payer: Cash Price |
$81.99
|
| Rate for Payer: Central Health Plan Commercial |
$145.77
|
| Rate for Payer: Cigna of CA HMO |
$116.61
|
| Rate for Payer: Cigna of CA PPO |
$134.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.88
|
| Rate for Payer: Galaxy Health WC |
$154.88
|
| Rate for Payer: Global Benefits Group Commercial |
$109.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$136.66
|
| Rate for Payer: IEHP medi-cal |
$63.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.44
|
| Rate for Payer: Multiplan Commercial |
$136.66
|
| Rate for Payer: Networks By Design Commercial |
$118.44
|
| Rate for Payer: Prime Health Services Commercial |
$154.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$109.33
|
| Rate for Payer: Riverside University Health MISP |
$72.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.10
|
| Rate for Payer: United Healthcare All Other HMO |
$91.10
|
| Rate for Payer: United Healthcare HMO Rider |
$91.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.88
|
| Rate for Payer: Vantage Medical Group Senior |
$154.88
|
|
|
HC TRAY CATH SLCN 18FR URN MTR
|
Facility
IP
|
$117.12
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$105.41 |
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Central Health Plan Commercial |
$93.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.85
|
| Rate for Payer: Galaxy Health WC |
$99.55
|
| Rate for Payer: Global Benefits Group Commercial |
$70.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Multiplan Commercial |
$87.84
|
| Rate for Payer: Networks By Design Commercial |
$76.13
|
| Rate for Payer: Prime Health Services Commercial |
$99.55
|
|
