|
HC ROOM REHAB ACUTE 1:4
|
Facility
IP
|
$4,464.00
|
|
| Hospital Charge Code |
992300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$892.80 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Blue Shield of California Commercial |
$4,068.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,919.00
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,571.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Galaxy Health WC |
$3,794.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,678.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,017.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: IEHP medi-cal |
$1,672.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,977.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.80
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,794.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION
|
Facility
IP
|
$5,124.00
|
|
| Hospital Charge Code |
902300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,024.80 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Blue Shield of California Commercial |
$4,068.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,919.00
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,099.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,049.60
|
| Rate for Payer: Galaxy Health WC |
$4,355.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,074.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,611.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: IEHP medi-cal |
$1,672.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,417.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,024.80
|
| Rate for Payer: Multiplan Commercial |
$3,843.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,355.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION 1:4
|
Facility
IP
|
$5,124.00
|
|
| Hospital Charge Code |
992300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,024.80 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Blue Shield of California Commercial |
$4,068.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,919.00
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,099.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,049.60
|
| Rate for Payer: Galaxy Health WC |
$4,355.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,074.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,611.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: IEHP medi-cal |
$1,672.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,417.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,024.80
|
| Rate for Payer: Multiplan Commercial |
$3,843.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,355.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE
|
Facility
IP
|
$6,875.00
|
|
| Hospital Charge Code |
902311817
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$9,809.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,040.00
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE ISOLATION
|
Facility
IP
|
$8,827.00
|
|
| Hospital Charge Code |
902311819
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,765.40 |
| Max. Negotiated Rate |
$9,809.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,040.00
|
| Rate for Payer: Cash Price |
$3,972.15
|
| Rate for Payer: Cash Price |
$3,972.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,061.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,530.80
|
| Rate for Payer: Galaxy Health WC |
$7,502.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,296.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,944.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,887.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,765.40
|
| Rate for Payer: Multiplan Commercial |
$6,620.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,502.95
|
|
|
HC ROOM TRAUMA ACUTE
|
Facility
IP
|
$7,098.00
|
|
| Hospital Charge Code |
902300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,419.60 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$3,194.10
|
| Rate for Payer: Cash Price |
$3,194.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,678.40
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,839.20
|
| Rate for Payer: Galaxy Health WC |
$6,033.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,258.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,388.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,734.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.60
|
| Rate for Payer: Multiplan Commercial |
$5,323.50
|
| Rate for Payer: Networks By Design Commercial |
$4,613.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,033.30
|
|
|
HC ROOM TRAUMA ACUTE 1:4
|
Facility
IP
|
$5,724.00
|
|
| Hospital Charge Code |
992300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,144.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,579.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,289.60
|
| Rate for Payer: Galaxy Health WC |
$4,865.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,151.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,817.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.80
|
| Rate for Payer: Multiplan Commercial |
$4,293.00
|
| Rate for Payer: Networks By Design Commercial |
$3,720.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,865.40
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION
|
Facility
IP
|
$7,416.00
|
|
| Hospital Charge Code |
902300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,483.20 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,932.80
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,966.40
|
| Rate for Payer: Galaxy Health WC |
$6,303.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,449.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,674.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,946.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.20
|
| Rate for Payer: Multiplan Commercial |
$5,562.00
|
| Rate for Payer: Networks By Design Commercial |
$4,820.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,303.60
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION 1:4
|
Facility
IP
|
$7,416.00
|
|
| Hospital Charge Code |
992300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,483.20 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,932.80
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,966.40
|
| Rate for Payer: Galaxy Health WC |
$6,303.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,449.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,674.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,946.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.20
|
| Rate for Payer: Multiplan Commercial |
$5,562.00
|
| Rate for Payer: Networks By Design Commercial |
$4,820.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,303.60
|
|
|
HC ROOM TRAUMA DOU/INTEREDIATE ISOLATION
|
Facility
IP
|
$11,777.00
|
|
| Hospital Charge Code |
902311719
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,355.40 |
| Max. Negotiated Rate |
$10,599.30 |
| Rate for Payer: Blue Shield of California Commercial |
$9,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,040.00
|
| Rate for Payer: Cash Price |
$5,299.65
|
| Rate for Payer: Cash Price |
$5,299.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,421.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,710.80
|
| Rate for Payer: Galaxy Health WC |
$10,010.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,066.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,599.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,855.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,355.40
|
| Rate for Payer: Multiplan Commercial |
$8,832.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,010.45
|
|
|
HC ROOM TRAUMA DOU/INTERMEDIATE
|
Facility
IP
|
$9,828.00
|
|
| Hospital Charge Code |
902311717
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,965.60 |
| Max. Negotiated Rate |
$9,809.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,040.00
|
| Rate for Payer: Cash Price |
$4,422.60
|
| Rate for Payer: Cash Price |
$4,422.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,862.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,931.20
|
| Rate for Payer: Galaxy Health WC |
$8,353.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,896.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,845.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,555.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,965.60
|
| Rate for Payer: Multiplan Commercial |
$7,371.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,353.80
|
|
|
HC ROOM TRAUMA ICU
|
Facility
IP
|
$27,062.00
|
|
| Hospital Charge Code |
902314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$24,355.80 |
| Rate for Payer: Blue Shield of California Commercial |
$13,446.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,649.00
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Central Health Plan Commercial |
$21,649.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,824.80
|
| Rate for Payer: Galaxy Health WC |
$23,002.70
|
| Rate for Payer: Global Benefits Group Commercial |
$16,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,355.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,050.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,412.40
|
| Rate for Payer: Multiplan Commercial |
$20,296.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,002.70
|
|
|
HC ROOM TRAUMA ICU 1:1
|
Facility
IP
|
$27,062.00
|
|
| Hospital Charge Code |
992314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$24,355.80 |
| Rate for Payer: Blue Shield of California Commercial |
$13,446.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,649.00
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Central Health Plan Commercial |
$21,649.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,824.80
|
| Rate for Payer: Galaxy Health WC |
$23,002.70
|
| Rate for Payer: Global Benefits Group Commercial |
$16,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,355.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,050.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,412.40
|
| Rate for Payer: Multiplan Commercial |
$20,296.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,002.70
|
|
|
HC ROOM TRAUMA ICU ISOLATION
|
Facility
IP
|
$25,608.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,047.20 |
| Rate for Payer: Blue Shield of California Commercial |
$13,446.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,649.00
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Central Health Plan Commercial |
$20,486.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,243.20
|
| Rate for Payer: Galaxy Health WC |
$21,766.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,364.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,047.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,080.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,121.60
|
| Rate for Payer: Multiplan Commercial |
$19,206.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,766.80
|
|
|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
IP
|
$25,608.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,047.20 |
| Rate for Payer: Blue Shield of California Commercial |
$13,446.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,649.00
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Central Health Plan Commercial |
$20,486.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,243.20
|
| Rate for Payer: Galaxy Health WC |
$21,766.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,364.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,047.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,080.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,121.60
|
| Rate for Payer: Multiplan Commercial |
$19,206.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,766.80
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$5,717.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,717.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,210.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,004.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,225.96
|
| Rate for Payer: BCBS Transplant Transplant |
$1,320.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,650.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,197.34
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,650.75
|
| Rate for Payer: IEHP medi-cal |
$770.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: Riverside University Health MISP |
$880.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,100.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,100.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,100.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,980.90 |
| Rate for Payer: Blue Shield of California EPN |
$1,175.33
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Central Health Plan Commercial |
$428.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$481.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$259.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.08
|
| Rate for Payer: BCBS Transplant Transplant |
$321.00
|
| Rate for Payer: Blue Shield of California Commercial |
$336.52
|
| Rate for Payer: Blue Shield of California EPN |
$261.62
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Central Health Plan Commercial |
$428.00
|
| Rate for Payer: Cigna of CA HMO |
$342.40
|
| Rate for Payer: Cigna of CA PPO |
$395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$481.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$401.25
|
| Rate for Payer: IEHP medi-cal |
$187.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: Riverside University Health MISP |
$214.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
IP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,263.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
OP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$2,522.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,522.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$772.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$772.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$679.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$829.48
|
| Rate for Payer: BCBS Transplant Transplant |
$842.40
|
| Rate for Payer: Blue Shield of California Commercial |
$883.12
|
| Rate for Payer: Blue Shield of California EPN |
$686.56
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,123.20
|
| Rate for Payer: Cigna of CA HMO |
$898.56
|
| Rate for Payer: Cigna of CA PPO |
$1,038.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,193.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,263.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,053.00
|
| Rate for Payer: IEHP medi-cal |
$491.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$842.40
|
| Rate for Payer: Riverside University Health MISP |
$561.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$842.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$702.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$702.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,193.40
|
|
|
HC ROTOVIRUS AG
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: BCBS Transplant Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: IEHP medi-cal |
$19.77
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Innovage PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: Riverside University Health MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC ROTOVIRUS AG
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Blue Shield of California EPN |
$214.13
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.35 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$347.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$220.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.91
|
| Rate for Payer: BCBS Transplant Transplant |
$240.60
|
| Rate for Payer: Blue Shield of California Commercial |
$300.75
|
| Rate for Payer: Blue Shield of California EPN |
$218.14
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$300.75
|
| Rate for Payer: IEHP medi-cal |
$140.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.41
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$200.50
|
| Rate for Payer: United Healthcare All Other HMO |
$200.50
|
| Rate for Payer: United Healthcare HMO Rider |
$200.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
