|
HC TRANSFUS BLOOD OR BLOOD COMPONENTS
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
910100056
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$555.48 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,641.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$246.20 |
| Max. Negotiated Rate |
$1,107.90 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Central Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$492.40
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$761.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.20
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$246.20 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$752.14
|
| Rate for Payer: Blue Shield of California EPN |
$491.17
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Central Health Plan Commercial |
$984.80
|
| Rate for Payer: Cigna of CA HMO |
$787.84
|
| Rate for Payer: Cigna of CA PPO |
$910.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$532.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUSION BLOOD OR BLOOD COMPONENTS
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
948100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$678.20 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,099.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC TRANSFUSION BLOOD OR BLOOD COMPONENTS
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
948100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$555.48 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,641.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TRANSORL LWR ESPHGL MYOTOMY
|
Facility
|
IP
|
$10,618.00
|
|
|
Service Code
|
CPT 43497
|
| Hospital Charge Code |
906703497
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,123.60 |
| Max. Negotiated Rate |
$9,556.20 |
| Rate for Payer: Adventist Health Commercial |
$2,123.60
|
| Rate for Payer: Cash Price |
$5,839.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,247.20
|
| Rate for Payer: Galaxy Health WC |
$9,025.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,082.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,045.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,572.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,123.60
|
| Rate for Payer: Multiplan Commercial |
$7,963.50
|
| Rate for Payer: Networks By Design Commercial |
$6,901.70
|
| Rate for Payer: Prime Health Services Commercial |
$9,025.30
|
|
|
HC TRANSORL LWR ESPHGL MYOTOMY
|
Facility
|
OP
|
$10,618.00
|
|
|
Service Code
|
CPT 43497
|
| Hospital Charge Code |
906703497
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,173.13 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,123.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,563.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,839.90
|
| Rate for Payer: Cash Price |
$5,839.90
|
| Rate for Payer: Cash Price |
$5,839.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,494.40
|
| Rate for Payer: Cigna of CA HMO |
$6,795.52
|
| Rate for Payer: Cigna of CA PPO |
$7,857.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Galaxy Health WC |
$9,025.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,556.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,173.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: InnovAge PACE Commercial |
$11,345.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,082.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,295.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,123.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,135.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$7,963.50
|
| Rate for Payer: Networks By Design Commercial |
$6,901.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Prime Health Services Commercial |
$9,025.30
|
| Rate for Payer: Prime Health Services Medicare |
$8,017.46
|
| Rate for Payer: Riverside University Health System MISP |
$8,320.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,370.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC TRANS PREP/CRYO/STORAGE
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 38207
|
| Hospital Charge Code |
911800303
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$578.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$581.67
|
| Rate for Payer: Blue Shield of California EPN |
$379.85
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANS PREP/CRYO/STORAGE
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 38207
|
| Hospital Charge Code |
911800303
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$589.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
|
HC TRANSTHYRETIN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$106.43 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$66.77
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.70
|
| Rate for Payer: EPIC Health Plan Senior |
$14.59
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.59
|
| Rate for Payer: InnovAge PACE Commercial |
$21.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.55
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.59
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$15.47
|
| Rate for Payer: Riverside University Health System MISP |
$16.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO |
$11.82
|
| Rate for Payer: United Healthcare HMO Rider |
$11.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14.59
|
|
|
HC TRANSTHYRETIN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
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: Adventist Health Commercial |
$13,049.80
|
| Rate for Payer: Cash Price |
$35,886.95
|
| Rate for Payer: Central Health Plan Commercial |
$52,199.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,099.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$24,859.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,389.13
|
| 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 |
$31,998.11
|
| Rate for Payer: United Healthcare All Other HMO |
$29,414.25
|
| Rate for Payer: United Healthcare HMO Rider |
$28,239.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25,871.23
|
|
|
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: Adventist Health Commercial |
$13,049.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49,497.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55,461.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35,886.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48,936.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,966.00
|
| Rate for Payer: Blue Shield of California Commercial |
$39,867.14
|
| Rate for Payer: Blue Shield of California EPN |
$26,034.35
|
| Rate for Payer: Cash Price |
$35,886.95
|
| Rate for Payer: Cash Price |
$35,886.95
|
| 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: Dignity Health Medi-Cal |
$55,461.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55,461.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,099.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$32,624.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43,521.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,859.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,389.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,049.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,674.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,674.30
|
| Rate for Payer: Multiplan Commercial |
$48,936.75
|
| Rate for Payer: Networks By Design Commercial |
$42,411.85
|
| Rate for Payer: Prime Health Services Commercial |
$55,461.65
|
| Rate for Payer: Riverside University Health System 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 |
$31,998.11
|
| Rate for Payer: United Healthcare All Other HMO |
$29,414.25
|
| Rate for Payer: United Healthcare HMO Rider |
$28,239.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25,871.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55,461.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55,461.65
|
| Rate for Payer: Vantage Medical Group Senior |
$55,461.65
|
|
|
HC TRAUMA ACTIVATION LEVEL B
|
Facility
|
IP
|
$38,814.00
|
|
| Hospital Charge Code |
904300101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$7,762.80 |
| Max. Negotiated Rate |
$34,932.60 |
| Rate for Payer: Adventist Health Commercial |
$7,762.80
|
| Rate for Payer: Cash Price |
$21,347.70
|
| Rate for Payer: Central Health Plan Commercial |
$31,051.20
|
| 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 Permanente of CA Commercial/Self Funded |
$25,888.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,788.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,025.87
|
| 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 |
$10,966.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23,715.35
|
| Rate for Payer: Blue Shield of California EPN |
$15,486.79
|
| Rate for Payer: Cash Price |
$21,347.70
|
| Rate for Payer: Cash Price |
$21,347.70
|
| 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: 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: InnovAge PACE Commercial |
$19,407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,888.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,788.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,025.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,762.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,169.80
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$10,966.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,473.76
|
| Rate for Payer: Blue Shield of California EPN |
$6,839.66
|
| Rate for Payer: Cash Price |
$9,428.10
|
| Rate for Payer: Cash Price |
$9,428.10
|
| 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: 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: InnovAge PACE Commercial |
$8,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,433.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,531.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,610.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,428.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,999.40
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$9,428.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,713.60
|
| 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 Permanente of CA Commercial/Self Funded |
$11,433.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,531.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,610.90
|
| 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 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 |
$354.53
|
| Rate for Payer: Blue Shield of California Commercial |
$368.84
|
| Rate for Payer: Blue Shield of California EPN |
$240.86
|
| Rate for Payer: Cash Price |
$332.01
|
| 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: 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: InnovAge PACE Commercial |
$301.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.56
|
| Rate for Payer: Molina Healthcare of CA 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 |
$332.01
|
| Rate for Payer: Central Health Plan Commercial |
$482.93
|
| 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 Permanente of CA Commercial/Self Funded |
$402.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.67
|
| 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 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 |
$98.46
|
| 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 |
$95.21
|
| Rate for Payer: Blue Shield of California Commercial |
$99.06
|
| Rate for Payer: Blue Shield of California EPN |
$64.69
|
| Rate for Payer: Cash Price |
$89.17
|
| 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: 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: InnovAge PACE Commercial |
$81.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.48
|
| Rate for Payer: Molina Healthcare of CA 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 |
$89.17
|
| Rate for Payer: Central Health Plan Commercial |
$129.70
|
| 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 Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| 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
|
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 |
$64.06
|
| 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 |
$61.95
|
| Rate for Payer: Blue Shield of California Commercial |
$64.45
|
| Rate for Payer: Blue Shield of California EPN |
$42.09
|
| Rate for Payer: Cash Price |
$58.02
|
| 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: 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: InnovAge PACE Commercial |
$52.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.84
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$58.02
|
| Rate for Payer: Central Health Plan Commercial |
$84.39
|
| 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 Permanente of CA Commercial/Self Funded |
$70.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.30
|
| 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
|
|
