|
HC L&D EA ADD'L 15 MIN
|
Facility
|
OP
|
$952.00
|
|
| Hospital Charge Code |
902400057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$809.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$714.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$584.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$809.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$809.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$589.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$666.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$666.40
|
| Rate for Payer: Multiplan Commercial |
$761.60
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other HMO |
$476.00
|
| Rate for Payer: United Healthcare HMO Rider |
$476.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$809.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.20
|
| Rate for Payer: Vantage Medical Group Senior |
$809.20
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
IP
|
$4,505.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.00 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: Adventist Health Commercial |
$901.00
|
| Rate for Payer: Cash Price |
$2,477.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,802.00
|
| Rate for Payer: Galaxy Health WC |
$3,829.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,703.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,004.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,716.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,788.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,081.20
|
| Rate for Payer: Multiplan Commercial |
$3,604.00
|
| Rate for Payer: Networks By Design Commercial |
$2,928.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,829.25
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
OP
|
$4,505.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$901.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,829.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,477.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,766.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,477.75
|
| Rate for Payer: Cash Price |
$2,477.75
|
| Rate for Payer: Cigna of CA HMO |
$2,883.20
|
| Rate for Payer: Cigna of CA PPO |
$3,333.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,829.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,829.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,829.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,802.00
|
| Rate for Payer: Galaxy Health WC |
$3,829.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,703.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,004.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,716.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,788.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,081.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,153.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,153.50
|
| Rate for Payer: Multiplan Commercial |
$3,604.00
|
| Rate for Payer: Networks By Design Commercial |
$2,928.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,829.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,703.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,252.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,252.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,252.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,252.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,829.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,829.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,829.25
|
|
|
HC L&D LEVEL II - 1ST HR
|
Facility
|
OP
|
$5,516.00
|
|
| Hospital Charge Code |
902400052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,103.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,103.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,688.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,033.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,387.38
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,033.80
|
| Rate for Payer: Cash Price |
$3,033.80
|
| Rate for Payer: Cigna of CA HMO |
$3,530.24
|
| Rate for Payer: Cigna of CA PPO |
$4,081.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,688.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,688.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,688.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,206.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,206.40
|
| Rate for Payer: Galaxy Health WC |
$4,688.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,309.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,679.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,101.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,414.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,861.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,861.20
|
| Rate for Payer: Multiplan Commercial |
$4,412.80
|
| Rate for Payer: Networks By Design Commercial |
$3,585.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,688.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,309.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,758.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,758.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,688.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,688.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,688.60
|
|
|
HC L&D LEVEL II - 1ST HR
|
Facility
|
IP
|
$5,516.00
|
|
| Hospital Charge Code |
902400052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,103.20 |
| Max. Negotiated Rate |
$4,688.60 |
| Rate for Payer: Adventist Health Commercial |
$1,103.20
|
| Rate for Payer: Cash Price |
$3,033.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,206.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,206.40
|
| Rate for Payer: Galaxy Health WC |
$4,688.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,309.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,679.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,101.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,414.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.84
|
| Rate for Payer: Multiplan Commercial |
$4,412.80
|
| Rate for Payer: Networks By Design Commercial |
$3,585.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,688.60
|
|
|
HC L&D LEVEL III - 1ST HR
|
Facility
|
IP
|
$6,471.00
|
|
| Hospital Charge Code |
902400054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,294.20 |
| Max. Negotiated Rate |
$5,500.35 |
| Rate for Payer: Adventist Health Commercial |
$1,294.20
|
| Rate for Payer: Cash Price |
$3,559.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,588.40
|
| Rate for Payer: Galaxy Health WC |
$5,500.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,882.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,465.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,005.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,553.04
|
| Rate for Payer: Multiplan Commercial |
$5,176.80
|
| Rate for Payer: Networks By Design Commercial |
$4,206.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,500.35
|
|
|
HC L&D LEVEL III - 1ST HR
|
Facility
|
OP
|
$6,471.00
|
|
| Hospital Charge Code |
902400054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,294.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,294.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,500.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,559.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,853.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,973.84
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,559.05
|
| Rate for Payer: Cash Price |
$3,559.05
|
| Rate for Payer: Cigna of CA HMO |
$4,141.44
|
| Rate for Payer: Cigna of CA PPO |
$4,788.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,500.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,500.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,500.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,588.40
|
| Rate for Payer: Galaxy Health WC |
$5,500.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,882.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,465.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,005.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,553.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,529.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,529.70
|
| Rate for Payer: Multiplan Commercial |
$5,176.80
|
| Rate for Payer: Networks By Design Commercial |
$4,206.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,500.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,882.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,235.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,235.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,235.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,235.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,500.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,500.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,500.35
|
|
|
HC L&D LEVEL II OBSERV ADDL 1 HR
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
902400383
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.31
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC L&D LEVEL II OBSERV ADDL 1 HR
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
902400383
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC L&D LEVEL I OBSERVATION ADDL 1 HR
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
902400381
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.31
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC L&D LEVEL I OBSERVATION ADDL 1 HR
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
902400381
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC L&D LEVEL I OBSERV - INIT 1 HR
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
902400380
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC L&D LEVEL I OBSERV - INIT 1 HR
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
902400380
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.31
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC L&D LEVEL IV - 1ST HR
|
Facility
|
OP
|
$6,857.00
|
|
| Hospital Charge Code |
902400056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,371.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,371.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,828.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,771.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,142.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,210.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,771.35
|
| Rate for Payer: Cash Price |
$3,771.35
|
| Rate for Payer: Cigna of CA HMO |
$4,388.48
|
| Rate for Payer: Cigna of CA PPO |
$5,074.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,828.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,828.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,828.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,742.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,742.80
|
| Rate for Payer: Galaxy Health WC |
$5,828.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,114.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,573.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,612.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,244.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,645.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,799.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,799.90
|
| Rate for Payer: Multiplan Commercial |
$5,485.60
|
| Rate for Payer: Networks By Design Commercial |
$4,457.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,828.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,114.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,428.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,428.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,428.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,828.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,828.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,828.45
|
|
|
HC L&D LEVEL IV - 1ST HR
|
Facility
|
IP
|
$6,857.00
|
|
| Hospital Charge Code |
902400056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,371.40 |
| Max. Negotiated Rate |
$5,828.45 |
| Rate for Payer: Adventist Health Commercial |
$1,371.40
|
| Rate for Payer: Cash Price |
$3,771.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,742.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,742.80
|
| Rate for Payer: Galaxy Health WC |
$5,828.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,114.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,573.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,612.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,244.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,645.68
|
| Rate for Payer: Multiplan Commercial |
$5,485.60
|
| Rate for Payer: Networks By Design Commercial |
$4,457.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,828.45
|
|
|
HC L&D TREATMENT ROOM
|
Facility
|
IP
|
$368.00
|
|
| Hospital Charge Code |
902400418
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
|
|
HC L&D TREATMENT ROOM
|
Facility
|
OP
|
$368.00
|
|
| Hospital Charge Code |
902400418
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$241.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$276.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.99
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$235.52
|
| Rate for Payer: Cigna of CA PPO |
$272.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$312.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$312.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$312.80
|
| Rate for Payer: Vantage Medical Group Senior |
$312.80
|
|
|
HC LEAD BIOTRONIK LINOX SMART S
|
Facility
|
IP
|
$7,500.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813789
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Cigna of CA HMO |
$5,250.00
|
| Rate for Payer: Cigna of CA PPO |
$5,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,000.00
|
| Rate for Payer: Galaxy Health WC |
$6,375.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,857.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,642.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Multiplan Commercial |
$6,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,814.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,680.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,456.25
|
|
|
HC LEAD BIOTRONIK LINOX SMART S
|
Facility
|
OP
|
$7,500.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813789
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$6,375.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,125.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,605.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5,535.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,645.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Cigna of CA HMO |
$5,250.00
|
| Rate for Payer: Cigna of CA PPO |
$5,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,375.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,000.00
|
| Rate for Payer: Galaxy Health WC |
$6,375.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,642.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,250.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,250.00
|
| Rate for Payer: Multiplan Commercial |
$6,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,375.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,814.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,680.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,456.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,375.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,375.00
|
|
|
HC LEAD BIOTRONIK PLEXA 402266
|
Facility
|
IP
|
$8,000.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813806
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Cigna of CA HMO |
$5,600.00
|
| Rate for Payer: Cigna of CA PPO |
$5,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,200.00
|
| Rate for Payer: Galaxy Health WC |
$6,800.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,800.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,048.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,952.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.00
|
| Rate for Payer: Multiplan Commercial |
$6,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,922.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,859.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,620.00
|
|
|
HC LEAD BIOTRONIK PLEXA 402266
|
Facility
|
OP
|
$8,000.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813806
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$6,800.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,400.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,912.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,904.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,888.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Cigna of CA HMO |
$5,600.00
|
| Rate for Payer: Cigna of CA PPO |
$5,600.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,800.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,200.00
|
| Rate for Payer: Galaxy Health WC |
$6,800.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,800.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,952.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,600.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,600.00
|
| Rate for Payer: Multiplan Commercial |
$6,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,800.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,922.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,859.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,620.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,800.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,800.00
|
|
|
HC LEAD BIOTRONIK PLEXA S 414005
|
Facility
|
OP
|
$8,000.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813798
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$6,800.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,400.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,912.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,904.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,888.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Cigna of CA HMO |
$5,600.00
|
| Rate for Payer: Cigna of CA PPO |
$5,600.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,800.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,200.00
|
| Rate for Payer: Galaxy Health WC |
$6,800.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,800.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,952.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,600.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,600.00
|
| Rate for Payer: Multiplan Commercial |
$6,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,800.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,922.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,859.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,620.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,800.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,800.00
|
|
|
HC LEAD BIOTRONIK PLEXA S 414005
|
Facility
|
IP
|
$8,000.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813798
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Cigna of CA HMO |
$5,600.00
|
| Rate for Payer: Cigna of CA PPO |
$5,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,200.00
|
| Rate for Payer: Galaxy Health WC |
$6,800.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,800.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,048.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,952.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.00
|
| Rate for Payer: Multiplan Commercial |
$6,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,922.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,859.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,620.00
|
|
|
HC LEAD BIOTRONIK PROTEGO S
|
Facility
|
IP
|
$7,500.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813785
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Cigna of CA HMO |
$5,250.00
|
| Rate for Payer: Cigna of CA PPO |
$5,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,000.00
|
| Rate for Payer: Galaxy Health WC |
$6,375.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,857.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,642.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Multiplan Commercial |
$6,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,814.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,680.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,456.25
|
|
|
HC LEAD BIOTRONIK PROTEGO S
|
Facility
|
OP
|
$7,500.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813785
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$6,375.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,125.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,605.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5,535.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,645.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Cigna of CA HMO |
$5,250.00
|
| Rate for Payer: Cigna of CA PPO |
$5,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,375.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,000.00
|
| Rate for Payer: Galaxy Health WC |
$6,375.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,642.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,250.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,250.00
|
| Rate for Payer: Multiplan Commercial |
$6,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,375.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,814.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,680.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,456.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,375.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,375.00
|
|
