|
HC ECHO TRANSTHO W/CONT COMPLETE
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT C8921
|
| Hospital Charge Code |
900200240
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,253.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
|
OP
|
$3,932.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$412.39 |
| Max. Negotiated Rate |
$3,538.80 |
| Rate for Payer: Adventist Health Commercial |
$786.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$696.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,387.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,653.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,309.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,386.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,561.00
|
| Rate for Payer: Cash Price |
$1,769.40
|
| Rate for Payer: Cash Price |
$1,769.40
|
| Rate for Payer: Cash Price |
$1,769.40
|
| Rate for Payer: Center for Health Promotion Commercial |
$490.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,145.60
|
| Rate for Payer: Cigna of CA HMO |
$2,516.48
|
| Rate for Payer: Cigna of CA PPO |
$2,909.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$3,342.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,359.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,538.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,622.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$933.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$2,949.00
|
| Rate for Payer: Networks By Design Commercial |
$2,555.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$696.67
|
| Rate for Payer: Prime Health Services Commercial |
$3,342.20
|
| Rate for Payer: Prime Health Services Medicare |
$738.47
|
| Rate for Payer: Riverside University Health System MISP |
$766.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,359.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,359.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
|
IP
|
$3,932.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$786.40 |
| Max. Negotiated Rate |
$3,538.80 |
| Rate for Payer: Adventist Health Commercial |
$786.40
|
| Rate for Payer: Cash Price |
$1,769.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,572.80
|
| Rate for Payer: Galaxy Health WC |
$3,342.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,359.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,538.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,622.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,498.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,433.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.40
|
| Rate for Payer: Multiplan Commercial |
$2,949.00
|
| Rate for Payer: Networks By Design Commercial |
$2,555.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,342.20
|
|
|
HC ECMO CIRCUIT & SET-UP INITIAL
|
Facility
|
IP
|
$39,830.00
|
|
| Hospital Charge Code |
900190010
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$7,966.00 |
| Max. Negotiated Rate |
$35,847.00 |
| Rate for Payer: Adventist Health Commercial |
$7,966.00
|
| Rate for Payer: Cash Price |
$17,923.50
|
| Rate for Payer: Central Health Plan Commercial |
$31,864.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,932.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,932.00
|
| Rate for Payer: Galaxy Health WC |
$33,855.50
|
| Rate for Payer: Global Benefits Group Commercial |
$23,898.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,847.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,566.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,175.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,654.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,966.00
|
| Rate for Payer: Multiplan Commercial |
$29,872.50
|
| Rate for Payer: Networks By Design Commercial |
$25,889.50
|
| Rate for Payer: Prime Health Services Commercial |
$33,855.50
|
|
|
HC ECMO CIRCUIT & SET-UP INITIAL
|
Facility
|
OP
|
$39,830.00
|
|
| Hospital Charge Code |
900190010
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$35,847.00 |
| Rate for Payer: Adventist Health Commercial |
$7,966.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,188.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,855.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,906.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,872.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$17,923.50
|
| Rate for Payer: Cash Price |
$17,923.50
|
| Rate for Payer: Cash Price |
$17,923.50
|
| Rate for Payer: Central Health Plan Commercial |
$31,864.00
|
| Rate for Payer: Cigna of CA HMO |
$25,491.20
|
| Rate for Payer: Cigna of CA PPO |
$29,474.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,855.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,855.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33,855.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,932.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,932.00
|
| Rate for Payer: Galaxy Health WC |
$33,855.50
|
| Rate for Payer: Global Benefits Group Commercial |
$23,898.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,847.00
|
| Rate for Payer: InnovAge PACE Commercial |
$19,915.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,566.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,175.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,654.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,966.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,881.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,881.00
|
| Rate for Payer: Multiplan Commercial |
$29,872.50
|
| Rate for Payer: Networks By Design Commercial |
$25,889.50
|
| Rate for Payer: Prime Health Services Commercial |
$33,855.50
|
| Rate for Payer: Riverside University Health System MISP |
$15,932.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,898.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,898.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,855.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33,855.50
|
| Rate for Payer: Vantage Medical Group Senior |
$33,855.50
|
|
|
HC ECMO EQUIP & MONITOR EA 4 HRS
|
Facility
|
OP
|
$1,073.00
|
|
| Hospital Charge Code |
900190021
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$214.60 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Adventist Health Commercial |
$214.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$651.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$804.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Central Health Plan Commercial |
$858.40
|
| Rate for Payer: Cigna of CA HMO |
$686.72
|
| Rate for Payer: Cigna of CA PPO |
$794.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$912.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.20
|
| Rate for Payer: EPIC Health Plan Senior |
$429.20
|
| Rate for Payer: Galaxy Health WC |
$912.05
|
| Rate for Payer: Global Benefits Group Commercial |
$643.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$965.70
|
| Rate for Payer: InnovAge PACE Commercial |
$536.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$664.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$751.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$751.10
|
| Rate for Payer: Multiplan Commercial |
$804.75
|
| Rate for Payer: Networks By Design Commercial |
$697.45
|
| Rate for Payer: Prime Health Services Commercial |
$912.05
|
| Rate for Payer: Riverside University Health System MISP |
$429.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$643.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$643.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$912.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.05
|
| Rate for Payer: Vantage Medical Group Senior |
$912.05
|
|
|
HC ECMO EQUIP & MONITOR EA 4 HRS
|
Facility
|
IP
|
$1,073.00
|
|
| Hospital Charge Code |
900190021
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$214.60 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Adventist Health Commercial |
$214.60
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Central Health Plan Commercial |
$858.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.20
|
| Rate for Payer: EPIC Health Plan Senior |
$429.20
|
| Rate for Payer: Galaxy Health WC |
$912.05
|
| Rate for Payer: Global Benefits Group Commercial |
$643.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$965.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$664.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.60
|
| Rate for Payer: Multiplan Commercial |
$804.75
|
| Rate for Payer: Networks By Design Commercial |
$697.45
|
| Rate for Payer: Prime Health Services Commercial |
$912.05
|
|
|
HC ECMO RE-PRIME BLADDER
|
Facility
|
IP
|
$1,916.00
|
|
| Hospital Charge Code |
900190033
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$383.20 |
| Max. Negotiated Rate |
$1,724.40 |
| Rate for Payer: Adventist Health Commercial |
$383.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.40
|
| Rate for Payer: EPIC Health Plan Senior |
$766.40
|
| Rate for Payer: Galaxy Health WC |
$1,628.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,724.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,186.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.20
|
| Rate for Payer: Multiplan Commercial |
$1,437.00
|
| Rate for Payer: Networks By Design Commercial |
$1,245.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,628.60
|
|
|
HC ECMO RE-PRIME BLADDER
|
Facility
|
OP
|
$1,916.00
|
|
| Hospital Charge Code |
900190033
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$1,724.40 |
| Rate for Payer: Adventist Health Commercial |
$383.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,163.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,628.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,437.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.80
|
| Rate for Payer: Cigna of CA HMO |
$1,226.24
|
| Rate for Payer: Cigna of CA PPO |
$1,417.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,628.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,628.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,628.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.40
|
| Rate for Payer: EPIC Health Plan Senior |
$766.40
|
| Rate for Payer: Galaxy Health WC |
$1,628.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,724.40
|
| Rate for Payer: InnovAge PACE Commercial |
$958.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,186.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,341.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,341.20
|
| Rate for Payer: Multiplan Commercial |
$1,437.00
|
| Rate for Payer: Networks By Design Commercial |
$1,245.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,628.60
|
| Rate for Payer: Riverside University Health System MISP |
$766.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,628.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,628.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,628.60
|
|
|
HC ECMO RE-PRIME CANNULAE
|
Facility
|
IP
|
$896.00
|
|
| Hospital Charge Code |
900190036
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Adventist Health Commercial |
$179.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Central Health Plan Commercial |
$716.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.40
|
| Rate for Payer: EPIC Health Plan Senior |
$358.40
|
| Rate for Payer: Galaxy Health WC |
$761.60
|
| Rate for Payer: Global Benefits Group Commercial |
$537.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$806.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$597.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$554.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.20
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$582.40
|
| Rate for Payer: Prime Health Services Commercial |
$761.60
|
|
|
HC ECMO RE-PRIME CANNULAE
|
Facility
|
OP
|
$896.00
|
|
| Hospital Charge Code |
900190036
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Adventist Health Commercial |
$179.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$544.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$672.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Central Health Plan Commercial |
$716.80
|
| Rate for Payer: Cigna of CA HMO |
$573.44
|
| Rate for Payer: Cigna of CA PPO |
$663.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$761.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$761.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.40
|
| Rate for Payer: EPIC Health Plan Senior |
$358.40
|
| Rate for Payer: Galaxy Health WC |
$761.60
|
| Rate for Payer: Global Benefits Group Commercial |
$537.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$806.40
|
| Rate for Payer: InnovAge PACE Commercial |
$448.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$597.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$554.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.20
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$582.40
|
| Rate for Payer: Prime Health Services Commercial |
$761.60
|
| Rate for Payer: Riverside University Health System MISP |
$358.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$761.60
|
| Rate for Payer: Vantage Medical Group Senior |
$761.60
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
|
IP
|
$14,452.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$2,890.40 |
| Max. Negotiated Rate |
$13,006.80 |
| Rate for Payer: Adventist Health Commercial |
$2,890.40
|
| Rate for Payer: Cash Price |
$6,503.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,780.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,780.80
|
| Rate for Payer: Galaxy Health WC |
$12,284.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,671.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,006.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,639.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,506.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,945.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,890.40
|
| Rate for Payer: Multiplan Commercial |
$10,839.00
|
| Rate for Payer: Networks By Design Commercial |
$9,393.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,284.20
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
|
OP
|
$14,452.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$13,006.80 |
| Rate for Payer: Adventist Health Commercial |
$2,890.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,776.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,284.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,948.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,839.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$6,503.40
|
| Rate for Payer: Cash Price |
$6,503.40
|
| Rate for Payer: Cash Price |
$6,503.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,561.60
|
| Rate for Payer: Cigna of CA HMO |
$9,249.28
|
| Rate for Payer: Cigna of CA PPO |
$10,694.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,284.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,284.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,284.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,780.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,780.80
|
| Rate for Payer: Galaxy Health WC |
$12,284.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,671.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,006.80
|
| Rate for Payer: InnovAge PACE Commercial |
$7,226.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,639.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,506.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,945.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,890.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,116.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,116.40
|
| Rate for Payer: Multiplan Commercial |
$10,839.00
|
| Rate for Payer: Networks By Design Commercial |
$9,393.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,284.20
|
| Rate for Payer: Riverside University Health System MISP |
$5,780.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,671.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,671.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,284.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,284.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12,284.20
|
|
|
HC ECMO RE-PRIME HEAT EXCHANGE
|
Facility
|
OP
|
$2,669.00
|
|
| Hospital Charge Code |
900190032
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$2,402.10 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,620.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,467.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,135.20
|
| Rate for Payer: Cigna of CA HMO |
$1,708.16
|
| Rate for Payer: Cigna of CA PPO |
$1,975.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,268.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,268.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,402.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,334.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,780.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,016.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,652.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,868.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,868.30
|
| Rate for Payer: Multiplan Commercial |
$2,001.75
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,067.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,601.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,601.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,268.65
|
|
|
HC ECMO RE-PRIME HEAT EXCHANGE
|
Facility
|
IP
|
$2,669.00
|
|
| Hospital Charge Code |
900190032
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$2,402.10 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,402.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,780.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,016.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,652.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.80
|
| Rate for Payer: Multiplan Commercial |
$2,001.75
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
OP
|
$1,173.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$750.72
|
| Rate for Payer: Cigna of CA PPO |
$868.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: InnovAge PACE Commercial |
$586.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$821.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$821.10
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Riverside University Health System MISP |
$469.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.05
|
| Rate for Payer: Vantage Medical Group Senior |
$997.05
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
IP
|
$1,173.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
OP
|
$5,854.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$5,268.60 |
| Rate for Payer: Adventist Health Commercial |
$1,170.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,555.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,975.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,219.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,390.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$2,634.30
|
| Rate for Payer: Cash Price |
$2,634.30
|
| Rate for Payer: Cash Price |
$2,634.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,683.20
|
| Rate for Payer: Cigna of CA HMO |
$3,746.56
|
| Rate for Payer: Cigna of CA PPO |
$4,331.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,975.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,975.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,975.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,341.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,341.60
|
| Rate for Payer: Galaxy Health WC |
$4,975.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,268.60
|
| Rate for Payer: InnovAge PACE Commercial |
$2,927.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,904.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,230.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,097.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,097.80
|
| Rate for Payer: Multiplan Commercial |
$4,390.50
|
| Rate for Payer: Networks By Design Commercial |
$3,805.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,341.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,512.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,512.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,975.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,975.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,975.90
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
IP
|
$5,854.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$1,170.80 |
| Max. Negotiated Rate |
$5,268.60 |
| Rate for Payer: Adventist Health Commercial |
$1,170.80
|
| Rate for Payer: Cash Price |
$2,634.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,683.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,341.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,341.60
|
| Rate for Payer: Galaxy Health WC |
$4,975.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,268.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,904.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,230.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.80
|
| Rate for Payer: Multiplan Commercial |
$4,390.50
|
| Rate for Payer: Networks By Design Commercial |
$3,805.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.90
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
IP
|
$597.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$537.30 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Central Health Plan Commercial |
$477.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$238.80
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$537.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.40
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
OP
|
$597.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$537.30 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$362.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$507.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$447.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Central Health Plan Commercial |
$477.60
|
| Rate for Payer: Cigna of CA HMO |
$382.08
|
| Rate for Payer: Cigna of CA PPO |
$441.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$507.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$238.80
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$537.30
|
| Rate for Payer: InnovAge PACE Commercial |
$298.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$417.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$417.90
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
| Rate for Payer: Riverside University Health System MISP |
$238.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$507.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.45
|
| Rate for Payer: Vantage Medical Group Senior |
$507.45
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
IP
|
$3,765.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$753.00 |
| Max. Negotiated Rate |
$3,388.50 |
| Rate for Payer: Adventist Health Commercial |
$753.00
|
| Rate for Payer: Cash Price |
$1,694.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,012.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,506.00
|
| Rate for Payer: Galaxy Health WC |
$3,200.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,259.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,388.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,511.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,330.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.00
|
| Rate for Payer: Multiplan Commercial |
$2,823.75
|
| Rate for Payer: Networks By Design Commercial |
$2,447.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,200.25
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
OP
|
$3,765.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$3,388.50 |
| Rate for Payer: Adventist Health Commercial |
$753.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,286.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,200.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,823.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$1,694.25
|
| Rate for Payer: Cash Price |
$1,694.25
|
| Rate for Payer: Cash Price |
$1,694.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,012.00
|
| Rate for Payer: Cigna of CA HMO |
$2,409.60
|
| Rate for Payer: Cigna of CA PPO |
$2,786.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,200.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,200.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,200.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,506.00
|
| Rate for Payer: Galaxy Health WC |
$3,200.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,259.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,388.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,882.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,511.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,330.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,635.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,635.50
|
| Rate for Payer: Multiplan Commercial |
$2,823.75
|
| Rate for Payer: Networks By Design Commercial |
$2,447.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,200.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,506.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,259.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,259.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,200.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,200.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,200.25
|
|
|
HC ECOG IMPLTD BRN NPGT 30 DYS
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
900695836
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC ECOG IMPLTD BRN NPGT 30 DYS
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
900695836
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$614.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.57
|
| Rate for Payer: Blue Shield of California Commercial |
$87.41
|
| Rate for Payer: Blue Shield of California EPN |
$57.17
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$159.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: InnovAge PACE Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Medicare |
$50.22
|
| Rate for Payer: Riverside University Health System MISP |
$52.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
