|
HC YANKAUER REG CAP FLANGE
|
Facility
|
IP
|
$4.43
|
|
| Hospital Charge Code |
901607937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$3.32
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
|
|
HC YANKAUER REG CAP FLANGE
|
Facility
|
OP
|
$4.43
|
|
| Hospital Charge Code |
901607937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$3.32
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
| Rate for Payer: Riverside University Health System MISP |
$1.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
HC YANKAUER RIGID W/FLANGE TIP
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Central Health Plan Commercial |
$3.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.38
|
| Rate for Payer: Networks By Design Commercial |
$2.93
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
|
|
HC YANKAUER RIGID W/FLANGE TIP
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
CPT A4628
|
| Hospital Charge Code |
901698698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Central Health Plan Commercial |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$2.89
|
| Rate for Payer: Cigna of CA PPO |
$3.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$3.38
|
| Rate for Payer: Networks By Design Commercial |
$2.93
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
| Rate for Payer: Riverside University Health System MISP |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.83
|
|
|
HC YANKAUER RIGID W/OPEN TIP STL
|
Facility
|
OP
|
$4.35
|
|
| Hospital Charge Code |
901698716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
HC YANKAUER RIGID W/OPEN TIP STL
|
Facility
|
IP
|
$4.35
|
|
| Hospital Charge Code |
901698716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
HC YANKAUER SUCTN FLEXI FINE CAP
|
Facility
|
IP
|
$4.43
|
|
| Hospital Charge Code |
901698615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$3.32
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
|
|
HC YANKAUER SUCTN FLEXI FINE CAP
|
Facility
|
OP
|
$4.43
|
|
| Hospital Charge Code |
901698615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$3.32
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
| Rate for Payer: Riverside University Health System MISP |
$1.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
HC YANKAUER TIP ON/OFF CNTRL
|
Facility
|
OP
|
$9.92
|
|
| Hospital Charge Code |
901607946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.77
|
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.96
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.94
|
| Rate for Payer: Cigna of CA HMO |
$6.35
|
| Rate for Payer: Cigna of CA PPO |
$7.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Senior |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$7.44
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
| Rate for Payer: Riverside University Health System MISP |
$3.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.43
|
| Rate for Payer: Vantage Medical Group Senior |
$8.43
|
|
|
HC YANKAUER TIP ON/OFF CNTRL
|
Facility
|
IP
|
$9.92
|
|
| Hospital Charge Code |
901607946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Senior |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.44
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
|
|
HC YOKE TYPE ARM SUSPENSION SUPPO
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT L3969
|
| Hospital Charge Code |
903203969
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,056.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$528.00
|
| Rate for Payer: Galaxy Health WC |
$1,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,188.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$838.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: Networks By Design Commercial |
$858.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.00
|
|
|
HC YOKE TYPE ARM SUSPENSION SUPPO
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT L3969
|
| Hospital Charge Code |
903203969
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$801.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$726.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$639.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.84
|
| Rate for Payer: Blue Shield of California Commercial |
$836.88
|
| Rate for Payer: Blue Shield of California EPN |
$526.68
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,056.00
|
| Rate for Payer: Cigna of CA HMO |
$844.80
|
| Rate for Payer: Cigna of CA PPO |
$976.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,122.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,122.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$528.00
|
| Rate for Payer: Galaxy Health WC |
$1,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,188.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$838.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$479.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$924.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: Networks By Design Commercial |
$858.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.00
|
| Rate for Payer: Riverside University Health System MISP |
$528.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$792.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$792.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,122.00
|
|
|
HC Y STENT W POSTS AND 1MM WALL THCKNSS
|
Facility
|
IP
|
$2,214.00
|
|
| Hospital Charge Code |
900800913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.80 |
| Max. Negotiated Rate |
$1,992.60 |
| Rate for Payer: Adventist Health Commercial |
$442.80
|
| Rate for Payer: Cash Price |
$996.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,771.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,549.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.60
|
| Rate for Payer: EPIC Health Plan Senior |
$885.60
|
| Rate for Payer: Galaxy Health WC |
$1,881.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,328.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,992.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,405.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,306.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.80
|
| Rate for Payer: Multiplan Commercial |
$1,660.50
|
| Rate for Payer: Networks By Design Commercial |
$1,439.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.90
|
|
|
HC Y STENT W POSTS AND 1MM WALL THCKNSS
|
Facility
|
OP
|
$2,214.00
|
|
| Hospital Charge Code |
900800913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.80 |
| Max. Negotiated Rate |
$1,992.60 |
| Rate for Payer: Adventist Health Commercial |
$442.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,344.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,881.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,217.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,660.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,072.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,287.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,403.68
|
| Rate for Payer: Blue Shield of California EPN |
$883.39
|
| Rate for Payer: Cash Price |
$996.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,771.20
|
| Rate for Payer: Cigna of CA HMO |
$1,416.96
|
| Rate for Payer: Cigna of CA PPO |
$1,638.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,881.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,881.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,881.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,549.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.60
|
| Rate for Payer: EPIC Health Plan Senior |
$885.60
|
| Rate for Payer: Galaxy Health WC |
$1,881.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,328.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,992.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,405.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$803.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,306.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,549.80
|
| Rate for Payer: Multiplan Commercial |
$1,660.50
|
| Rate for Payer: Networks By Design Commercial |
$1,439.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,881.90
|
| Rate for Payer: Riverside University Health System MISP |
$885.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,328.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,328.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,107.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,107.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,107.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,107.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,881.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,881.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,881.90
|
|
|
HC ZELANTE CATHETER
|
Facility
|
OP
|
$8,798.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.60 |
| Max. Negotiated Rate |
$7,918.20 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,838.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,598.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,017.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,824.82
|
| Rate for Payer: Blue Shield of California Commercial |
$7,056.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,434.19
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,038.40
|
| Rate for Payer: Cigna of CA HMO |
$6,158.60
|
| Rate for Payer: Cigna of CA PPO |
$6,158.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,478.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,478.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,158.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,519.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,519.20
|
| Rate for Payer: Galaxy Health WC |
$7,478.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,278.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,918.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,586.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,193.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,190.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,158.60
|
| Rate for Payer: Multiplan Commercial |
$6,598.50
|
| Rate for Payer: Networks By Design Commercial |
$4,399.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,478.30
|
| Rate for Payer: Riverside University Health System MISP |
$3,519.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,278.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,278.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,301.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,213.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,144.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,478.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7,478.30
|
|
|
HC ZELANTE CATHETER
|
Facility
|
IP
|
$8,798.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.60 |
| Max. Negotiated Rate |
$7,918.20 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,056.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,434.19
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,038.40
|
| Rate for Payer: Cigna of CA HMO |
$6,158.60
|
| Rate for Payer: Cigna of CA PPO |
$6,158.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,158.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,519.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,519.20
|
| Rate for Payer: Galaxy Health WC |
$7,478.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,278.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,918.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,586.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,190.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.60
|
| Rate for Payer: Multiplan Commercial |
$6,598.50
|
| Rate for Payer: Networks By Design Commercial |
$4,399.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,478.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,301.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,213.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,144.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.34
|
|
|
HC ZEPHYR 4.0 DELIVERY CATHETER
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
900800952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,337.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,458.20
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$834.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC ZEPHYR 4.0 DELIVERY CATHETER
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
900800952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC ZEPHYR 4.0 ENDOBRONCHIAL VALVE
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
900800950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,511.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,571.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,318.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
|
|
HC ZEPHYR 4.0 ENDOBRONCHIAL VALVE
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
900800950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,218.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,568.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,084.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4,511.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,781.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,781.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,571.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,041.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,318.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,937.50
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,375.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,781.25
|
|
|
HC ZEPHYR 4.0 LP ENDOBRONCHIAL VALVE
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
900800951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,218.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,568.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,084.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4,511.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,781.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,781.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,571.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,041.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,318.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,937.50
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,375.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,781.25
|
|
|
HC ZEPHYR 4.0 LP ENDOBRONCHIAL VALVE
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
900800951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,511.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,571.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,318.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
|
|
HC ZEPHYR 5.5 DUAL MARK DELIVERY CATHETER
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
900800953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,337.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,458.20
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$834.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC ZEPHYR 5.5 DUAL MARK DELIVERY CATHETER
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
900800953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HEADACHES WITH MCC
|
Facility
|
IP
|
$29,500.97
|
|
|
Service Code
|
MSDRG 102
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$29,500.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,500.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,056.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,679.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,995.80
|
| Rate for Payer: EPIC Health Plan Senior |
$17,997.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,361.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,905.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,923.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,361.09
|
| Rate for Payer: Prime Health Services Medicare |
$17,342.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
