|
HC PEDIATRIC ELECTRIC HAND
|
Facility
|
OP
|
$9,680.00
|
|
|
Service Code
|
CPT L7008
|
| Hospital Charge Code |
905357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,323.20 |
| Max. Negotiated Rate |
$8,228.00 |
| Rate for Payer: Adventist Health Commercial |
$3,968.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,228.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,324.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,260.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,606.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7,143.84
|
| Rate for Payer: Blue Shield of California EPN |
$4,704.48
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cigna of CA HMO |
$6,776.00
|
| Rate for Payer: Cigna of CA PPO |
$6,776.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,228.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,228.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,228.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,872.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,872.00
|
| Rate for Payer: Galaxy Health WC |
$8,228.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,808.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,503.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,354.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,991.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,323.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,776.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,776.00
|
| Rate for Payer: Multiplan Commercial |
$7,744.00
|
| Rate for Payer: Networks By Design Commercial |
$4,840.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,228.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,808.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,808.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,632.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3,536.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3,459.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,170.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,228.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,228.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,228.00
|
|
|
HC PEDIATRIC ELECTRIC HAND
|
Facility
|
IP
|
$9,680.00
|
|
|
Service Code
|
CPT L7008
|
| Hospital Charge Code |
905357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,936.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cigna of CA HMO |
$6,776.00
|
| Rate for Payer: Cigna of CA PPO |
$6,776.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,872.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,872.00
|
| Rate for Payer: Galaxy Health WC |
$8,228.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,808.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,688.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,991.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,323.20
|
| Rate for Payer: Multiplan Commercial |
$7,744.00
|
| Rate for Payer: Networks By Design Commercial |
$4,840.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,632.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3,536.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3,459.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,170.20
|
|
|
HC PEDIATRIC ELECTRIC HAND
|
Facility
|
IP
|
$9,680.00
|
|
|
Service Code
|
CPT L7008
|
| Hospital Charge Code |
915357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,936.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cigna of CA HMO |
$6,776.00
|
| Rate for Payer: Cigna of CA PPO |
$6,776.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,872.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,872.00
|
| Rate for Payer: Galaxy Health WC |
$8,228.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,808.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,688.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,991.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,323.20
|
| Rate for Payer: Multiplan Commercial |
$7,744.00
|
| Rate for Payer: Networks By Design Commercial |
$4,840.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,632.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3,536.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3,459.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,170.20
|
|
|
HC PEDIATRIC ELECTRIC HAND
|
Facility
|
OP
|
$9,680.00
|
|
|
Service Code
|
CPT L7008
|
| Hospital Charge Code |
915357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,323.20 |
| Max. Negotiated Rate |
$8,228.00 |
| Rate for Payer: Adventist Health Commercial |
$3,968.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,228.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,324.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,260.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,606.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7,143.84
|
| Rate for Payer: Blue Shield of California EPN |
$4,704.48
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cigna of CA HMO |
$6,776.00
|
| Rate for Payer: Cigna of CA PPO |
$6,776.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,228.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,228.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,228.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,872.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,872.00
|
| Rate for Payer: Galaxy Health WC |
$8,228.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,808.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,503.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,354.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,991.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,323.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,776.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,776.00
|
| Rate for Payer: Multiplan Commercial |
$7,744.00
|
| Rate for Payer: Networks By Design Commercial |
$4,840.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,228.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,808.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,808.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,632.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3,536.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3,459.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,170.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,228.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,228.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,228.00
|
|
|
HC PEDIAVASCULAR GUIDEWIRE SW30
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.95
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC PEDIAVASCULAR GUIDEWIRE SW30
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC PEDIAVASCULAR MONGOOSE 4.0 PIG
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.32
|
| Rate for Payer: Cash Price |
$160.60
|
| Rate for Payer: Cigna of CA HMO |
$186.88
|
| Rate for Payer: Cigna of CA PPO |
$216.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.00
|
| Rate for Payer: United Healthcare All Other HMO |
$146.00
|
| Rate for Payer: United Healthcare HMO Rider |
$146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC PEDIAVASCULAR MONGOOSE 4.0 PIG
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$160.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
|
|
HC PEDS PORT ACCESS KIT
|
Facility
|
OP
|
$4.10
|
|
| Hospital Charge Code |
901698559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC PEDS PORT ACCESS KIT
|
Facility
|
IP
|
$4.10
|
|
| Hospital Charge Code |
901698559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC PEDS URINE COLLCT CATH KIT 8FR
|
Facility
|
IP
|
$15.01
|
|
| Hospital Charge Code |
901698586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.01
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
|
|
HC PEDS URINE COLLCT CATH KIT 8FR
|
Facility
|
OP
|
$15.01
|
|
| Hospital Charge Code |
901698586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.22
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cigna of CA HMO |
$9.61
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$12.01
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.76
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC PED TERM DEV, HAND, VOL CLOSE
|
Facility
|
IP
|
$3,386.20
|
|
|
Service Code
|
CPT L6714
|
| Hospital Charge Code |
905356714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$677.24 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$677.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,862.41
|
| Rate for Payer: Cash Price |
$1,862.41
|
| Rate for Payer: Cigna of CA HMO |
$2,370.34
|
| Rate for Payer: Cigna of CA PPO |
$2,370.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,354.48
|
| Rate for Payer: Galaxy Health WC |
$2,878.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,258.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,290.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,096.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.69
|
| Rate for Payer: Multiplan Commercial |
$2,708.96
|
| Rate for Payer: Networks By Design Commercial |
$1,693.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,878.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,270.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,236.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,108.98
|
|
|
HC PED TERM DEV, HAND, VOL CLOSE
|
Facility
|
OP
|
$3,386.20
|
|
|
Service Code
|
CPT L6714
|
| Hospital Charge Code |
905356714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$812.69 |
| Max. Negotiated Rate |
$2,878.27 |
| Rate for Payer: Adventist Health Commercial |
$1,388.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,862.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,539.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,961.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2,499.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,645.69
|
| Rate for Payer: Cash Price |
$1,862.41
|
| Rate for Payer: Cash Price |
$1,862.41
|
| Rate for Payer: Cigna of CA HMO |
$2,370.34
|
| Rate for Payer: Cigna of CA PPO |
$2,370.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,878.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,878.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,354.48
|
| Rate for Payer: Galaxy Health WC |
$2,878.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,574.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,258.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,096.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,370.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,370.34
|
| Rate for Payer: Multiplan Commercial |
$2,708.96
|
| Rate for Payer: Networks By Design Commercial |
$1,693.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,878.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,031.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,031.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,270.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,236.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,108.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,878.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2,878.27
|
|
|
HC PED TERM DEV, HAND, VOL CLOSE
|
Facility
|
IP
|
$3,386.20
|
|
|
Service Code
|
CPT L6714
|
| Hospital Charge Code |
915356714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$677.24 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$677.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,862.41
|
| Rate for Payer: Cash Price |
$1,862.41
|
| Rate for Payer: Cigna of CA HMO |
$2,370.34
|
| Rate for Payer: Cigna of CA PPO |
$2,370.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,354.48
|
| Rate for Payer: Galaxy Health WC |
$2,878.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,258.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,290.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,096.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.69
|
| Rate for Payer: Multiplan Commercial |
$2,708.96
|
| Rate for Payer: Networks By Design Commercial |
$1,693.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,878.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,270.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,236.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,108.98
|
|
|
HC PED TERM DEV, HAND, VOL CLOSE
|
Facility
|
OP
|
$3,386.20
|
|
|
Service Code
|
CPT L6714
|
| Hospital Charge Code |
915356714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$812.69 |
| Max. Negotiated Rate |
$2,878.27 |
| Rate for Payer: Adventist Health Commercial |
$1,388.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,862.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,539.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,961.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2,499.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,645.69
|
| Rate for Payer: Cash Price |
$1,862.41
|
| Rate for Payer: Cash Price |
$1,862.41
|
| Rate for Payer: Cigna of CA HMO |
$2,370.34
|
| Rate for Payer: Cigna of CA PPO |
$2,370.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,878.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,878.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,354.48
|
| Rate for Payer: Galaxy Health WC |
$2,878.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,574.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,258.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,096.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,370.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,370.34
|
| Rate for Payer: Multiplan Commercial |
$2,708.96
|
| Rate for Payer: Networks By Design Commercial |
$1,693.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,878.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,031.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,031.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,270.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,236.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,108.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,878.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2,878.27
|
|
|
HC PED TERM DEV, HOOK, VOL CLOSE
|
Facility
|
IP
|
$3,448.30
|
|
|
Service Code
|
CPT L6712
|
| Hospital Charge Code |
915356712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$689.66 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$689.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,896.57
|
| Rate for Payer: Cash Price |
$1,896.57
|
| Rate for Payer: Cigna of CA HMO |
$2,413.81
|
| Rate for Payer: Cigna of CA PPO |
$2,413.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,379.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1,379.32
|
| Rate for Payer: Galaxy Health WC |
$2,931.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,068.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,300.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,313.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,134.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.59
|
| Rate for Payer: Multiplan Commercial |
$2,758.64
|
| Rate for Payer: Networks By Design Commercial |
$1,724.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,931.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,294.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1,259.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,232.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,129.32
|
|
|
HC PED TERM DEV, HOOK, VOL CLOSE
|
Facility
|
OP
|
$3,448.30
|
|
|
Service Code
|
CPT L6712
|
| Hospital Charge Code |
915356712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$827.59 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Adventist Health Commercial |
$1,413.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,931.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,896.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,586.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,997.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,544.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,675.87
|
| Rate for Payer: Cash Price |
$1,896.57
|
| Rate for Payer: Cash Price |
$1,896.57
|
| Rate for Payer: Cigna of CA HMO |
$2,413.81
|
| Rate for Payer: Cigna of CA PPO |
$2,413.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,931.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,931.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,931.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,379.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1,379.32
|
| Rate for Payer: Galaxy Health WC |
$2,931.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,068.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,473.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,300.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,134.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,413.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,413.81
|
| Rate for Payer: Multiplan Commercial |
$2,758.64
|
| Rate for Payer: Networks By Design Commercial |
$1,724.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,931.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,068.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,068.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,294.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1,259.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,232.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,129.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,931.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,931.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,931.05
|
|
|
HC PED TERM DEV, HOOK, VOL CLOSE
|
Facility
|
IP
|
$3,448.30
|
|
|
Service Code
|
CPT L6712
|
| Hospital Charge Code |
905356712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$689.66 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$689.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,896.57
|
| Rate for Payer: Cash Price |
$1,896.57
|
| Rate for Payer: Cigna of CA HMO |
$2,413.81
|
| Rate for Payer: Cigna of CA PPO |
$2,413.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,379.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1,379.32
|
| Rate for Payer: Galaxy Health WC |
$2,931.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,068.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,300.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,313.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,134.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.59
|
| Rate for Payer: Multiplan Commercial |
$2,758.64
|
| Rate for Payer: Networks By Design Commercial |
$1,724.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,931.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,294.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1,259.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,232.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,129.32
|
|
|
HC PED TERM DEV, HOOK, VOL CLOSE
|
Facility
|
OP
|
$3,448.30
|
|
|
Service Code
|
CPT L6712
|
| Hospital Charge Code |
905356712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$827.59 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Adventist Health Commercial |
$1,413.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,931.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,896.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,586.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,997.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,544.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,675.87
|
| Rate for Payer: Cash Price |
$1,896.57
|
| Rate for Payer: Cash Price |
$1,896.57
|
| Rate for Payer: Cigna of CA HMO |
$2,413.81
|
| Rate for Payer: Cigna of CA PPO |
$2,413.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,931.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,931.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,931.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,379.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1,379.32
|
| Rate for Payer: Galaxy Health WC |
$2,931.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,068.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,473.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,300.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,134.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,413.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,413.81
|
| Rate for Payer: Multiplan Commercial |
$2,758.64
|
| Rate for Payer: Networks By Design Commercial |
$1,724.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,931.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,068.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,068.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,294.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1,259.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,232.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,129.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,931.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,931.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,931.05
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
IP
|
$4,352.10
|
|
|
Service Code
|
CPT L6713
|
| Hospital Charge Code |
915356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$870.42 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$870.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.84
|
| Rate for Payer: Galaxy Health WC |
$3,699.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,902.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,693.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.50
|
| Rate for Payer: Multiplan Commercial |
$3,481.68
|
| Rate for Payer: Networks By Design Commercial |
$2,176.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,555.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.31
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
OP
|
$4,352.10
|
|
|
Service Code
|
CPT L6713
|
| Hospital Charge Code |
905356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,044.50 |
| Max. Negotiated Rate |
$3,699.28 |
| Rate for Payer: Adventist Health Commercial |
$1,784.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,393.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,264.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,520.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3,211.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,115.12
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,699.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,699.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.84
|
| Rate for Payer: Galaxy Health WC |
$3,699.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,859.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,902.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,102.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,693.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,046.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,046.47
|
| Rate for Payer: Multiplan Commercial |
$3,481.68
|
| Rate for Payer: Networks By Design Commercial |
$2,176.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,611.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,611.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,555.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,699.28
|
| Rate for Payer: Vantage Medical Group Senior |
$3,699.28
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
OP
|
$4,352.10
|
|
|
Service Code
|
CPT L6713
|
| Hospital Charge Code |
915356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,044.50 |
| Max. Negotiated Rate |
$3,699.28 |
| Rate for Payer: Adventist Health Commercial |
$1,784.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,393.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,264.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,520.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3,211.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,115.12
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,699.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,699.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.84
|
| Rate for Payer: Galaxy Health WC |
$3,699.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,859.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,902.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,102.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,693.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,046.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,046.47
|
| Rate for Payer: Multiplan Commercial |
$3,481.68
|
| Rate for Payer: Networks By Design Commercial |
$2,176.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,611.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,611.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,555.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,699.28
|
| Rate for Payer: Vantage Medical Group Senior |
$3,699.28
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
IP
|
$4,352.10
|
|
|
Service Code
|
CPT L6713
|
| Hospital Charge Code |
905356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$870.42 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$870.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.84
|
| Rate for Payer: Galaxy Health WC |
$3,699.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,902.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,693.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.50
|
| Rate for Payer: Multiplan Commercial |
$3,481.68
|
| Rate for Payer: Networks By Design Commercial |
$2,176.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,555.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.31
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
OP
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
915356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$800.12 |
| Max. Negotiated Rate |
$10,091.92 |
| Rate for Payer: Adventist Health Commercial |
$4,867.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,091.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,530.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,904.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,876.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,762.16
|
| Rate for Payer: Blue Shield of California EPN |
$5,770.21
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Cigna of CA HMO |
$8,311.00
|
| Rate for Payer: Cigna of CA PPO |
$8,311.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,091.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,091.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,091.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,749.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,749.14
|
| Rate for Payer: Galaxy Health WC |
$10,091.92
|
| Rate for Payer: Global Benefits Group Commercial |
$7,123.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$800.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,919.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,349.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,849.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,311.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,311.00
|
| Rate for Payer: Multiplan Commercial |
$9,498.28
|
| Rate for Payer: Networks By Design Commercial |
$5,936.43
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,123.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,123.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,455.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4,337.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4,243.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,888.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,091.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,091.92
|
| Rate for Payer: Vantage Medical Group Senior |
$10,091.92
|
|
