|
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 |
$2,482.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,861.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,502.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,254.44
|
| 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
|
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 |
$4,152.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,911.95
|
| Rate for Payer: Cash Price |
$2,911.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,529.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,109.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,348.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,817.89
|
| 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 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 |
$2,911.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,529.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,109.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,817.89
|
| 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 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 |
$80.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| 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 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 |
$114.22
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| 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 |
$80.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| 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 |
$114.22
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| 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 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 |
$114.22
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| 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 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 |
$80.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| 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 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 |
$4,400.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$3,085.65
|
| Rate for Payer: Cash Price |
$3,085.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,799.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,354.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,489.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,045.63
|
| 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 |
$3,085.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,799.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,354.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,045.63
|
| 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 |
$165.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| 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 |
$236.15
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| 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 INSERT CS, EXIST IMPL
|
Facility
|
IP
|
$53,604.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,720.80 |
| Max. Negotiated Rate |
$45,563.40 |
| Rate for Payer: Adventist Health Commercial |
$10,720.80
|
| Rate for Payer: Cash Price |
$24,121.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,522.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,441.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21,441.60
|
| Rate for Payer: Galaxy Health WC |
$45,563.40
|
| Rate for Payer: Global Benefits Group Commercial |
$32,162.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,038.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.96
|
| Rate for Payer: Multiplan Commercial |
$42,883.20
|
| Rate for Payer: Networks By Design Commercial |
$34,842.60
|
| Rate for Payer: Prime Health Services Commercial |
$45,563.40
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
OP
|
$53,604.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$469.73 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$10,720.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,443.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$24,121.80
|
| Rate for Payer: Cash Price |
$24,121.80
|
| Rate for Payer: Cash Price |
$24,121.80
|
| Rate for Payer: Cigna of CA HMO |
$34,306.56
|
| Rate for Payer: Cigna of CA PPO |
$39,666.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,787.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,443.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,522.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,180.97
|
| Rate for Payer: EPIC Health Plan Senior |
$14,787.31
|
| Rate for Payer: Galaxy Health WC |
$45,563.40
|
| Rate for Payer: Global Benefits Group Commercial |
$32,162.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,046.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,443.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,038.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$531.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,820.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,938.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,013.63
|
| Rate for Payer: Multiplan Commercial |
$42,883.20
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$34,842.60
|
| Rate for Payer: Prime Health Services Commercial |
$45,563.40
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32,162.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,802.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,443.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13,443.01
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
OP
|
$48,315.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906812215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$434.08 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$9,663.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,067.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,573.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,236.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Cash Price |
$21,741.75
|
| Rate for Payer: Cash Price |
$21,741.75
|
| Rate for Payer: Cash Price |
$21,741.75
|
| Rate for Payer: Cigna of CA HMO |
$30,921.60
|
| Rate for Payer: Cigna of CA PPO |
$35,753.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,067.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,067.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,067.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,326.00
|
| Rate for Payer: Galaxy Health WC |
$41,067.75
|
| Rate for Payer: Global Benefits Group Commercial |
$28,989.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$434.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,680.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$490.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,505.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,595.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,820.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,820.50
|
| Rate for Payer: Multiplan Commercial |
$38,652.00
|
| Rate for Payer: Networks By Design Commercial |
$31,404.75
|
| Rate for Payer: Prime Health Services Commercial |
$41,067.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,157.50
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,067.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,067.75
|
| Rate for Payer: Vantage Medical Group Senior |
$41,067.75
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
IP
|
$48,315.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906812215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,663.00 |
| Max. Negotiated Rate |
$41,067.75 |
| Rate for Payer: Adventist Health Commercial |
$9,663.00
|
| Rate for Payer: Cash Price |
$21,741.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,326.00
|
| Rate for Payer: Galaxy Health WC |
$41,067.75
|
| Rate for Payer: Global Benefits Group Commercial |
$28,989.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,680.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,505.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,595.60
|
| Rate for Payer: Multiplan Commercial |
$38,652.00
|
| Rate for Payer: Networks By Design Commercial |
$31,404.75
|
| Rate for Payer: Prime Health Services Commercial |
$41,067.75
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
OP
|
$16,355.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906811360
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.71 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,271.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,934.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$7,359.75
|
| Rate for Payer: Cash Price |
$7,359.75
|
| Rate for Payer: Cash Price |
$7,359.75
|
| Rate for Payer: Cigna of CA HMO |
$10,467.20
|
| Rate for Payer: Cigna of CA PPO |
$12,102.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,448.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,561.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11,707.88
|
| Rate for Payer: Galaxy Health WC |
$13,901.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,813.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,455.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,385.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,900.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,925.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,410.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$13,084.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$10,630.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,901.75
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,813.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,177.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,643.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
IP
|
$16,355.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906811360
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,271.00 |
| Max. Negotiated Rate |
$13,901.75 |
| Rate for Payer: Adventist Health Commercial |
$3,271.00
|
| Rate for Payer: Cash Price |
$7,359.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,448.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,542.00
|
| Rate for Payer: Galaxy Health WC |
$13,901.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,813.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,385.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,649.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,925.20
|
| Rate for Payer: Multiplan Commercial |
$13,084.00
|
| Rate for Payer: Networks By Design Commercial |
$10,630.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,901.75
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
OP
|
$16,355.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$750.56 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,271.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,934.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$7,359.75
|
| Rate for Payer: Cash Price |
$7,359.75
|
| Rate for Payer: Cash Price |
$7,359.75
|
| Rate for Payer: Cigna of CA HMO |
$10,467.20
|
| Rate for Payer: Cigna of CA PPO |
$12,102.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,448.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,561.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11,707.88
|
| Rate for Payer: Galaxy Health WC |
$13,901.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,813.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,455.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$750.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,385.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,900.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,925.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,410.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$13,084.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$10,630.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,901.75
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,813.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,177.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,643.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
IP
|
$16,355.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,271.00 |
| Max. Negotiated Rate |
$13,901.75 |
| Rate for Payer: Adventist Health Commercial |
$3,271.00
|
| Rate for Payer: Cash Price |
$7,359.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,448.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,542.00
|
| Rate for Payer: Galaxy Health WC |
$13,901.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,813.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,385.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,649.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,925.20
|
| Rate for Payer: Multiplan Commercial |
$13,084.00
|
| Rate for Payer: Networks By Design Commercial |
$10,630.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,901.75
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
IP
|
$12,940.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,588.00 |
| Max. Negotiated Rate |
$10,999.00 |
| Rate for Payer: Adventist Health Commercial |
$2,588.00
|
| Rate for Payer: Cash Price |
$5,823.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,176.00
|
| Rate for Payer: Galaxy Health WC |
$10,999.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,764.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,216.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,634.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,105.60
|
| Rate for Payer: Multiplan Commercial |
$10,352.00
|
| Rate for Payer: Networks By Design Commercial |
$8,411.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,999.00
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
OP
|
$12,940.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$495.99 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,588.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$5,823.00
|
| Rate for Payer: Cash Price |
$5,823.00
|
| Rate for Payer: Cash Price |
$5,823.00
|
| Rate for Payer: Cigna of CA HMO |
$8,281.60
|
| Rate for Payer: Cigna of CA PPO |
$9,575.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$10,999.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,764.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,216.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,056.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$10,352.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$8,411.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,999.00
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,470.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
IP
|
$12,940.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906811355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,588.00 |
| Max. Negotiated Rate |
$10,999.00 |
| Rate for Payer: Adventist Health Commercial |
$2,588.00
|
| Rate for Payer: Cash Price |
$5,823.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,176.00
|
| Rate for Payer: Galaxy Health WC |
$10,999.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,764.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,216.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,634.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,105.60
|
| Rate for Payer: Multiplan Commercial |
$10,352.00
|
| Rate for Payer: Networks By Design Commercial |
$8,411.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,999.00
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
OP
|
$12,940.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906811355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$354.01 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,588.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$5,823.00
|
| Rate for Payer: Cash Price |
$5,823.00
|
| Rate for Payer: Cash Price |
$5,823.00
|
| Rate for Payer: Cigna of CA HMO |
$8,281.60
|
| Rate for Payer: Cigna of CA PPO |
$9,575.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$10,999.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,764.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,216.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,056.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$10,352.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$8,411.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,999.00
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,470.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
