|
HC L&D EA ADD'L 15 MIN
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
902400057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
IP
|
$4,374.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,049.76 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$1,968.30
|
| Rate for Payer: Cash Price |
$1,968.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,749.60
|
| Rate for Payer: Galaxy Health WC |
$3,717.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,624.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,917.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.76
|
| Rate for Payer: Multiplan Commercial |
$3,499.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,717.90
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
OP
|
$4,374.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,049.76 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,868.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,717.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,405.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,405.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,606.03
|
| Rate for Payer: Blue Distinction Transplant |
$2,624.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,968.30
|
| Rate for Payer: Cash Price |
$1,968.30
|
| Rate for Payer: Cigna of CA PPO |
$3,236.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,717.90
|
| Rate for Payer: Dignity Health Media |
$3,717.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,717.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,749.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,749.60
|
| Rate for Payer: Galaxy Health WC |
$3,717.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,624.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,280.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,917.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.76
|
| Rate for Payer: Multiplan Commercial |
$3,499.20
|
| Rate for Payer: Networks By Design Commercial |
$2,843.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,717.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,624.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,187.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,717.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,717.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3,717.90
|
|
|
HC L&D LEVEL II - 1ST HR
|
Facility
|
IP
|
$5,356.00
|
|
| Hospital Charge Code |
902400052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,285.44 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,142.40
|
| Rate for Payer: Galaxy Health WC |
$4,552.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,213.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,572.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,040.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.44
|
| Rate for Payer: Multiplan Commercial |
$4,284.80
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,552.60
|
|
|
HC L&D LEVEL II - 1ST HR
|
Facility
|
OP
|
$5,356.00
|
|
| Hospital Charge Code |
902400052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,285.44 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,513.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,945.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,945.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,191.10
|
| Rate for Payer: Blue Distinction Transplant |
$3,213.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cigna of CA PPO |
$3,963.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Dignity Health Media |
$4,552.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,552.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,142.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,142.40
|
| Rate for Payer: Galaxy Health WC |
$4,552.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,213.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,017.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,572.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,040.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.44
|
| Rate for Payer: Multiplan Commercial |
$4,284.80
|
| Rate for Payer: Networks By Design Commercial |
$3,481.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,552.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,213.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,678.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,678.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,678.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,552.60
|
|
|
HC L&D LEVEL III - 1ST HR
|
Facility
|
OP
|
$6,283.00
|
|
| Hospital Charge Code |
902400054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,507.92 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,121.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,340.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,455.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,455.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,743.41
|
| Rate for Payer: Blue Distinction Transplant |
$3,769.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,827.35
|
| Rate for Payer: Cash Price |
$2,827.35
|
| Rate for Payer: Cigna of CA PPO |
$4,649.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,340.55
|
| Rate for Payer: Dignity Health Media |
$5,340.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,340.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,513.20
|
| Rate for Payer: Galaxy Health WC |
$5,340.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,769.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,712.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,190.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,393.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,507.92
|
| Rate for Payer: Multiplan Commercial |
$5,026.40
|
| Rate for Payer: Networks By Design Commercial |
$4,083.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,340.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,769.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,141.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,141.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,141.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,141.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,340.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,340.55
|
| Rate for Payer: Vantage Medical Group Senior |
$5,340.55
|
|
|
HC L&D LEVEL III - 1ST HR
|
Facility
|
IP
|
$6,283.00
|
|
| Hospital Charge Code |
902400054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,507.92 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,827.35
|
| Rate for Payer: Cash Price |
$2,827.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.20
|
| Rate for Payer: Galaxy Health WC |
$5,340.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,769.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,190.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,393.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,507.92
|
| Rate for Payer: Multiplan Commercial |
$5,026.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,340.55
|
|
|
HC L&D LEVEL II OBSERV ADDL 1 HR
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
902400383
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$41.52 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.07
|
| Rate for Payer: Blue Distinction Transplant |
$103.80
|
| Rate for Payer: Blue Shield of California Commercial |
$127.50
|
| Rate for Payer: Blue Shield of California EPN |
$101.03
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.05
|
| Rate for Payer: Dignity Health Media |
$147.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.05
|
| Rate for Payer: Vantage Medical Group Senior |
$147.05
|
|
|
HC L&D LEVEL II OBSERV ADDL 1 HR
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
902400383
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$41.52 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC L&D LEVEL I OBSERVATION ADDL 1 HR
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
902400381
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$41.52 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC L&D LEVEL I OBSERVATION ADDL 1 HR
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
902400381
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$41.52 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.07
|
| Rate for Payer: Blue Distinction Transplant |
$103.80
|
| Rate for Payer: Blue Shield of California Commercial |
$127.50
|
| Rate for Payer: Blue Shield of California EPN |
$101.03
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.05
|
| Rate for Payer: Dignity Health Media |
$147.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.05
|
| Rate for Payer: Vantage Medical Group Senior |
$147.05
|
|
|
HC L&D LEVEL I OBSERV - INIT 1 HR
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
902400380
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$41.52 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC L&D LEVEL I OBSERV - INIT 1 HR
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
902400380
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$41.52 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.07
|
| Rate for Payer: Blue Distinction Transplant |
$103.80
|
| Rate for Payer: Blue Shield of California Commercial |
$127.50
|
| Rate for Payer: Blue Shield of California EPN |
$101.03
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.05
|
| Rate for Payer: Dignity Health Media |
$147.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.05
|
| Rate for Payer: Vantage Medical Group Senior |
$147.05
|
|
|
HC L&D LEVEL IV - 1ST HR
|
Facility
|
OP
|
$6,658.00
|
|
| Hospital Charge Code |
902400056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,597.92 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,366.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,659.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,661.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,661.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,966.84
|
| Rate for Payer: Blue Distinction Transplant |
$3,994.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,996.10
|
| Rate for Payer: Cash Price |
$2,996.10
|
| Rate for Payer: Cigna of CA PPO |
$4,926.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,659.30
|
| Rate for Payer: Dignity Health Media |
$5,659.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,659.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,663.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,663.20
|
| Rate for Payer: Galaxy Health WC |
$5,659.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,994.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,993.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,440.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,536.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,597.92
|
| Rate for Payer: Multiplan Commercial |
$5,326.40
|
| Rate for Payer: Networks By Design Commercial |
$4,327.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,659.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,994.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,329.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,329.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,329.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,329.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,659.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,659.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,659.30
|
|
|
HC L&D LEVEL IV - 1ST HR
|
Facility
|
IP
|
$6,658.00
|
|
| Hospital Charge Code |
902400056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,597.92 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,996.10
|
| Rate for Payer: Cash Price |
$2,996.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,663.20
|
| Rate for Payer: Galaxy Health WC |
$5,659.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,994.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,440.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,536.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,597.92
|
| Rate for Payer: Multiplan Commercial |
$5,326.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,659.30
|
|
|
HC L&D TREATMENT ROOM
|
Facility
|
IP
|
$358.00
|
|
| Hospital Charge Code |
902400418
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.92
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Networks By Design Commercial |
$232.70
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
|
|
HC L&D TREATMENT ROOM
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
902400418
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$234.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.30
|
| Rate for Payer: Blue Distinction Transplant |
$214.80
|
| Rate for Payer: Blue Shield of California Commercial |
$263.85
|
| Rate for Payer: Blue Shield of California EPN |
$209.07
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna of CA HMO |
$229.12
|
| Rate for Payer: Cigna of CA PPO |
$264.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$304.30
|
| Rate for Payer: Dignity Health Media |
$304.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$304.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$268.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.92
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Networks By Design Commercial |
$232.70
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$304.30
|
| Rate for Payer: Vantage Medical Group Senior |
$304.30
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
IP
|
$54,838.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,161.12 |
| Max. Negotiated Rate |
$46,612.30 |
| Rate for Payer: Cash Price |
$24,677.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,935.20
|
| Rate for Payer: Galaxy Health WC |
$46,612.30
|
| Rate for Payer: Global Benefits Group Commercial |
$32,902.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36,576.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,893.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,161.12
|
| Rate for Payer: Multiplan Commercial |
$43,870.40
|
| Rate for Payer: Networks By Design Commercial |
$35,644.70
|
| Rate for Payer: Prime Health Services Commercial |
$46,612.30
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
OP
|
$54,838.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.24 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,341.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$32,902.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$24,677.10
|
| Rate for Payer: Cash Price |
$24,677.10
|
| Rate for Payer: Cigna of CA PPO |
$40,580.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Dignity Health Media |
$13,341.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,675.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,011.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,341.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,341.78
|
| Rate for Payer: Galaxy Health WC |
$46,612.30
|
| Rate for Payer: Global Benefits Group Commercial |
$32,902.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41,128.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,880.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$21,880.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,613.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21,613.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,341.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36,576.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$531.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,341.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,161.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,810.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,877.99
|
| Rate for Payer: Multiplan Commercial |
$43,870.40
|
| Rate for Payer: Multiplan WC |
$18,240.12
|
| Rate for Payer: Networks By Design Commercial |
$35,644.70
|
| Rate for Payer: Prime Health Services Commercial |
$46,612.30
|
| Rate for Payer: Prime Health Services WC |
$18,054.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32,902.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13,341.78
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
OP
|
$49,427.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906812215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.86 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,012.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,184.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,184.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$29,656.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$22,242.15
|
| Rate for Payer: Cash Price |
$22,242.15
|
| Rate for Payer: Cigna of CA PPO |
$36,575.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,012.95
|
| Rate for Payer: Dignity Health Media |
$42,012.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,012.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,770.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$19,770.80
|
| Rate for Payer: Galaxy Health WC |
$42,012.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29,656.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37,070.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,967.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,862.48
|
| Rate for Payer: Multiplan Commercial |
$39,541.60
|
| Rate for Payer: Networks By Design Commercial |
$32,127.55
|
| Rate for Payer: Prime Health Services Commercial |
$42,012.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,656.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,012.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,012.95
|
| Rate for Payer: Vantage Medical Group Senior |
$42,012.95
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
IP
|
$49,427.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906812215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,862.48 |
| Max. Negotiated Rate |
$42,012.95 |
| Rate for Payer: Cash Price |
$22,242.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,770.80
|
| Rate for Payer: Galaxy Health WC |
$42,012.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29,656.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,967.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,831.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,862.48
|
| Rate for Payer: Multiplan Commercial |
$39,541.60
|
| Rate for Payer: Networks By Design Commercial |
$32,127.55
|
| Rate for Payer: Prime Health Services Commercial |
$42,012.95
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
OP
|
$16,732.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906811360
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,201.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,039.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$7,529.40
|
| Rate for Payer: Cash Price |
$7,529.40
|
| Rate for Payer: Cash Price |
$7,529.40
|
| Rate for Payer: Cigna of CA PPO |
$12,381.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Media |
$10,614.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,329.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,614.79
|
| Rate for Payer: Galaxy Health WC |
$14,222.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,039.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,549.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,408.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$17,408.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,195.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$17,195.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,160.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,015.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,223.82
|
| Rate for Payer: Multiplan Commercial |
$13,385.60
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: Networks By Design Commercial |
$10,875.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,222.20
|
| Rate for Payer: Prime Health Services WC |
$14,363.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,039.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
IP
|
$16,732.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906811360
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,015.68 |
| Max. Negotiated Rate |
$14,222.20 |
| Rate for Payer: Cash Price |
$7,529.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,692.80
|
| Rate for Payer: Galaxy Health WC |
$14,222.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,039.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,160.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,374.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,015.68
|
| Rate for Payer: Multiplan Commercial |
$13,385.60
|
| Rate for Payer: Networks By Design Commercial |
$10,875.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,222.20
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
OP
|
$16,732.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,201.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,039.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$7,529.40
|
| Rate for Payer: Cash Price |
$7,529.40
|
| Rate for Payer: Cash Price |
$7,529.40
|
| Rate for Payer: Cigna of CA PPO |
$12,381.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Media |
$10,614.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,329.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,614.79
|
| Rate for Payer: Galaxy Health WC |
$14,222.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,039.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,549.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,408.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$17,408.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,195.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$17,195.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,160.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,015.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,223.82
|
| Rate for Payer: Multiplan Commercial |
$13,385.60
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: Networks By Design Commercial |
$10,875.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,222.20
|
| Rate for Payer: Prime Health Services WC |
$14,363.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,039.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
IP
|
$16,732.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,015.68 |
| Max. Negotiated Rate |
$14,222.20 |
| Rate for Payer: Cash Price |
$7,529.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,692.80
|
| Rate for Payer: Galaxy Health WC |
$14,222.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,039.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,160.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,374.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,015.68
|
| Rate for Payer: Multiplan Commercial |
$13,385.60
|
| Rate for Payer: Networks By Design Commercial |
$10,875.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,222.20
|
|
