|
HC ECHO TRANSTHO W/CONT 2D/M-MODE
|
Facility
|
IP
|
$3,647.00
|
|
|
Service Code
|
CPT C8924
|
| Hospital Charge Code |
900200243
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.40 |
| Max. Negotiated Rate |
$3,282.30 |
| Rate for Payer: Cash Price |
$1,641.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,458.80
|
| Rate for Payer: Galaxy Health WC |
$3,099.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,188.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,282.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,432.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,389.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.40
|
| Rate for Payer: Multiplan Commercial |
$2,735.25
|
| Rate for Payer: Networks By Design Commercial |
$2,370.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,099.95
|
|
|
HC ECHO TRANSTHO W/CONT 2D/M-MODE
|
Facility
|
OP
|
$3,647.00
|
|
|
Service Code
|
CPT C8924
|
| Hospital Charge Code |
900200243
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,282.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,763.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,765.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,154.65
|
| Rate for Payer: Blue Distinction Transplant |
$2,188.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,253.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,772.44
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,641.15
|
| Rate for Payer: Cash Price |
$1,641.15
|
| Rate for Payer: Cash Price |
$1,641.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,917.60
|
| Rate for Payer: Cigna of CA HMO |
$2,334.08
|
| Rate for Payer: Cigna of CA PPO |
$2,698.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,099.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,188.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,282.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,735.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,432.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,389.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$2,735.25
|
| Rate for Payer: Networks By Design Commercial |
$2,370.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,099.95
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,188.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,188.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ECHO TRANSTHO W/CONT COMPLETE
|
Facility
|
OP
|
$2,507.00
|
|
|
Service Code
|
CPT C8921
|
| Hospital Charge Code |
900200240
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$20,317.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20,317.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,213.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.14
|
| Rate for Payer: Blue Distinction Transplant |
$1,504.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,549.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: Cigna of CA HMO |
$1,604.48
|
| Rate for Payer: Cigna of CA PPO |
$1,855.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,880.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,504.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,504.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC ECHO TRANSTHO W/CONT COMPLETE
|
Facility
|
IP
|
$2,507.00
|
|
|
Service Code
|
CPT C8921
|
| Hospital Charge Code |
900200240
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$2,256.30 |
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.80
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
|
OP
|
$4,869.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$455.54 |
| Max. Negotiated Rate |
$4,382.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,003.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,653.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,876.61
|
| Rate for Payer: Blue Distinction Transplant |
$2,921.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,009.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,366.33
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$2,191.05
|
| Rate for Payer: Cash Price |
$2,191.05
|
| Rate for Payer: Cash Price |
$2,191.05
|
| Rate for Payer: Center for Health Promotion Commercial |
$490.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,895.20
|
| Rate for Payer: Cigna of CA HMO |
$3,116.16
|
| Rate for Payer: Cigna of CA PPO |
$3,603.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$4,138.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,921.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,382.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,651.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,137.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,247.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$973.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$3,651.75
|
| Rate for Payer: Networks By Design Commercial |
$3,164.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,138.65
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Riverside University Health System MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,921.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,921.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
|
IP
|
$4,869.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$973.80 |
| Max. Negotiated Rate |
$4,382.10 |
| Rate for Payer: Cash Price |
$2,191.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,895.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,947.60
|
| Rate for Payer: Galaxy Health WC |
$4,138.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,921.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,382.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,247.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,855.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$973.80
|
| Rate for Payer: Multiplan Commercial |
$3,651.75
|
| Rate for Payer: Networks By Design Commercial |
$3,164.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,138.65
|
|
|
HC ECMO CIRCUIT & SET-UP INITIAL
|
Facility
|
IP
|
$37,575.00
|
|
| Hospital Charge Code |
900190010
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$7,515.00 |
| Max. Negotiated Rate |
$33,817.50 |
| Rate for Payer: Cash Price |
$16,908.75
|
| Rate for Payer: Central Health Plan Commercial |
$30,060.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,030.00
|
| Rate for Payer: Galaxy Health WC |
$31,938.75
|
| Rate for Payer: Global Benefits Group Commercial |
$22,545.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,817.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,062.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,316.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,515.00
|
| Rate for Payer: Multiplan Commercial |
$28,181.25
|
| Rate for Payer: Networks By Design Commercial |
$24,423.75
|
| Rate for Payer: Prime Health Services Commercial |
$31,938.75
|
|
|
HC ECMO CIRCUIT & SET-UP INITIAL
|
Facility
|
OP
|
$37,575.00
|
|
| Hospital Charge Code |
900190010
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$33,817.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,819.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,938.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,666.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,666.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$22,545.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23,634.68
|
| Rate for Payer: Blue Shield of California EPN |
$18,374.18
|
| Rate for Payer: Cash Price |
$16,908.75
|
| Rate for Payer: Cash Price |
$16,908.75
|
| Rate for Payer: Cash Price |
$16,908.75
|
| Rate for Payer: Central Health Plan Commercial |
$30,060.00
|
| Rate for Payer: Cigna of CA HMO |
$24,048.00
|
| Rate for Payer: Cigna of CA PPO |
$27,805.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,938.75
|
| Rate for Payer: Dignity Health Media |
$31,938.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,938.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,030.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$15,030.00
|
| Rate for Payer: Galaxy Health WC |
$31,938.75
|
| Rate for Payer: Global Benefits Group Commercial |
$22,545.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,817.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28,181.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,151.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,062.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,316.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,515.00
|
| Rate for Payer: Multiplan Commercial |
$28,181.25
|
| Rate for Payer: Networks By Design Commercial |
$24,423.75
|
| Rate for Payer: Prime Health Services Commercial |
$31,938.75
|
| Rate for Payer: Riverside University Health System MISP |
$15,030.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,545.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,938.75
|
| Rate for Payer: Vantage Medical Group Senior |
$31,938.75
|
|
|
HC ECMO EQUIP & MONITOR EA 4 HRS
|
Facility
|
OP
|
$1,012.00
|
|
| Hospital Charge Code |
900190021
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$614.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$556.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$607.20
|
| Rate for Payer: Blue Shield of California Commercial |
$636.55
|
| Rate for Payer: Blue Shield of California EPN |
$494.87
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$647.68
|
| Rate for Payer: Cigna of CA PPO |
$748.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Media |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$759.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Riverside University Health System MISP |
$404.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC ECMO EQUIP & MONITOR EA 4 HRS
|
Facility
|
IP
|
$1,012.00
|
|
| Hospital Charge Code |
900190021
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
|
|
HC ECMO RE-PRIME BLADDER
|
Facility
|
OP
|
$1,808.00
|
|
| Hospital Charge Code |
900190033
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,098.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$994.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,084.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,137.23
|
| Rate for Payer: Blue Shield of California EPN |
$884.11
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,157.12
|
| Rate for Payer: Cigna of CA PPO |
$1,337.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Dignity Health Media |
$1,536.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,356.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$632.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$1,175.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Riverside University Health System MISP |
$723.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC ECMO RE-PRIME BLADDER
|
Facility
|
IP
|
$1,808.00
|
|
| Hospital Charge Code |
900190033
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$1,175.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
|
|
HC ECMO RE-PRIME CANNULAE
|
Facility
|
OP
|
$845.00
|
|
| Hospital Charge Code |
900190036
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$513.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$718.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$464.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$507.00
|
| Rate for Payer: Blue Shield of California Commercial |
$531.50
|
| Rate for Payer: Blue Shield of California EPN |
$413.20
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: Cigna of CA HMO |
$540.80
|
| Rate for Payer: Cigna of CA PPO |
$625.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$718.25
|
| Rate for Payer: Dignity Health Media |
$718.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$718.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$633.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
| Rate for Payer: Riverside University Health System MISP |
$338.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$718.25
|
| Rate for Payer: Vantage Medical Group Senior |
$718.25
|
|
|
HC ECMO RE-PRIME CANNULAE
|
Facility
|
IP
|
$845.00
|
|
| Hospital Charge Code |
900190036
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
|
OP
|
$13,634.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$12,270.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,279.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,588.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,498.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,498.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,180.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,575.79
|
| Rate for Payer: Blue Shield of California EPN |
$6,667.03
|
| Rate for Payer: Cash Price |
$6,135.30
|
| Rate for Payer: Cash Price |
$6,135.30
|
| Rate for Payer: Cash Price |
$6,135.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,907.20
|
| Rate for Payer: Cigna of CA HMO |
$8,725.76
|
| Rate for Payer: Cigna of CA PPO |
$10,089.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,588.90
|
| Rate for Payer: Dignity Health Media |
$11,588.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,588.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,453.60
|
| Rate for Payer: Galaxy Health WC |
$11,588.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,180.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,270.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,225.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,771.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,093.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,194.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,726.80
|
| Rate for Payer: Multiplan Commercial |
$10,225.50
|
| Rate for Payer: Networks By Design Commercial |
$8,862.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,588.90
|
| Rate for Payer: Riverside University Health System MISP |
$5,453.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,180.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,180.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,588.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11,588.90
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
|
IP
|
$13,634.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$2,726.80 |
| Max. Negotiated Rate |
$12,270.60 |
| Rate for Payer: Cash Price |
$6,135.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.60
|
| Rate for Payer: Galaxy Health WC |
$11,588.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,180.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,270.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,093.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,194.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,726.80
|
| Rate for Payer: Multiplan Commercial |
$10,225.50
|
| Rate for Payer: Networks By Design Commercial |
$8,862.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,588.90
|
|
|
HC ECMO RE-PRIME HEAT EXCHANGE
|
Facility
|
OP
|
$2,518.00
|
|
| Hospital Charge Code |
900190032
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$2,266.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,529.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,140.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,384.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,384.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,510.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,583.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,231.30
|
| Rate for Payer: Cash Price |
$1,133.10
|
| Rate for Payer: Cash Price |
$1,133.10
|
| Rate for Payer: Cash Price |
$1,133.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,014.40
|
| Rate for Payer: Cigna of CA HMO |
$1,611.52
|
| Rate for Payer: Cigna of CA PPO |
$1,863.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,140.30
|
| Rate for Payer: Dignity Health Media |
$2,140.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,140.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,007.20
|
| Rate for Payer: Galaxy Health WC |
$2,140.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,510.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,266.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,888.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$881.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,679.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$959.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.60
|
| Rate for Payer: Multiplan Commercial |
$1,888.50
|
| Rate for Payer: Networks By Design Commercial |
$1,636.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,140.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,007.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,510.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,510.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,140.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,140.30
|
|
|
HC ECMO RE-PRIME HEAT EXCHANGE
|
Facility
|
IP
|
$2,518.00
|
|
| Hospital Charge Code |
900190032
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$503.60 |
| Max. Negotiated Rate |
$2,266.20 |
| Rate for Payer: Cash Price |
$1,133.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,014.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.20
|
| Rate for Payer: Galaxy Health WC |
$2,140.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,510.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,266.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,679.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$959.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.60
|
| Rate for Payer: Multiplan Commercial |
$1,888.50
|
| Rate for Payer: Networks By Design Commercial |
$1,636.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,140.30
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
OP
|
$1,107.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$996.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$672.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$940.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$608.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$664.20
|
| Rate for Payer: Blue Shield of California Commercial |
$696.30
|
| Rate for Payer: Blue Shield of California EPN |
$541.32
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Central Health Plan Commercial |
$885.60
|
| Rate for Payer: Cigna of CA HMO |
$708.48
|
| Rate for Payer: Cigna of CA PPO |
$819.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$940.95
|
| Rate for Payer: Dignity Health Media |
$940.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$940.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$830.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$387.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
| Rate for Payer: Riverside University Health System MISP |
$442.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$664.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$940.95
|
| Rate for Payer: Vantage Medical Group Senior |
$940.95
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
IP
|
$1,107.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$996.30 |
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Central Health Plan Commercial |
$885.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$738.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
IP
|
$5,523.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$1,104.60 |
| Max. Negotiated Rate |
$4,970.70 |
| Rate for Payer: Cash Price |
$2,485.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,418.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,209.20
|
| Rate for Payer: Galaxy Health WC |
$4,694.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,970.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,683.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,104.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.60
|
| Rate for Payer: Multiplan Commercial |
$4,142.25
|
| Rate for Payer: Networks By Design Commercial |
$3,589.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,694.55
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
OP
|
$5,523.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$4,970.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,354.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,694.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,037.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,037.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,313.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,473.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,700.75
|
| Rate for Payer: Cash Price |
$2,485.35
|
| Rate for Payer: Cash Price |
$2,485.35
|
| Rate for Payer: Cash Price |
$2,485.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,418.40
|
| Rate for Payer: Cigna of CA HMO |
$3,534.72
|
| Rate for Payer: Cigna of CA PPO |
$4,087.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,694.55
|
| Rate for Payer: Dignity Health Media |
$4,694.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,694.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,209.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,209.20
|
| Rate for Payer: Galaxy Health WC |
$4,694.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,970.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,142.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,933.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,683.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,104.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.60
|
| Rate for Payer: Multiplan Commercial |
$4,142.25
|
| Rate for Payer: Networks By Design Commercial |
$3,589.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,694.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,209.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,313.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,694.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,694.55
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
OP
|
$563.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$341.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$337.80
|
| Rate for Payer: Blue Shield of California Commercial |
$354.13
|
| Rate for Payer: Blue Shield of California EPN |
$275.31
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| Rate for Payer: Cigna of CA HMO |
$360.32
|
| Rate for Payer: Cigna of CA PPO |
$416.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.55
|
| Rate for Payer: Dignity Health Media |
$478.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$506.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$422.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.60
|
| Rate for Payer: Multiplan Commercial |
$422.25
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
| Rate for Payer: Riverside University Health System MISP |
$225.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.55
|
| Rate for Payer: Vantage Medical Group Senior |
$478.55
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
IP
|
$563.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$506.70 |
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$506.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.60
|
| Rate for Payer: Multiplan Commercial |
$422.25
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
IP
|
$3,552.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$3,196.80 |
| Rate for Payer: Cash Price |
$1,598.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,420.80
|
| Rate for Payer: Galaxy Health WC |
$3,019.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,131.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,196.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,369.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,353.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Multiplan Commercial |
$2,664.00
|
| Rate for Payer: Networks By Design Commercial |
$2,308.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,019.20
|
|
