|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
OP
|
$36,145.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$30,723.25 |
| Rate for Payer: Adventist Health Commercial |
$7,229.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23,707.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,723.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,879.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$16,265.25
|
| Rate for Payer: Cash Price |
$16,265.25
|
| Rate for Payer: Cash Price |
$16,265.25
|
| Rate for Payer: Cigna of CA HMO |
$23,132.80
|
| Rate for Payer: Cigna of CA PPO |
$26,747.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,723.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,723.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,723.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,301.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,458.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,458.00
|
| Rate for Payer: Galaxy Health WC |
$30,723.25
|
| Rate for Payer: Global Benefits Group Commercial |
$21,687.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,952.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,120.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,325.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,674.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,301.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,301.50
|
| Rate for Payer: Multiplan Commercial |
$28,916.00
|
| Rate for Payer: Networks By Design Commercial |
$23,494.25
|
| Rate for Payer: Prime Health Services Commercial |
$30,723.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,687.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,687.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,723.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,723.25
|
| Rate for Payer: Vantage Medical Group Senior |
$30,723.25
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
IP
|
$36,145.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,229.00 |
| Max. Negotiated Rate |
$30,723.25 |
| Rate for Payer: Adventist Health Commercial |
$7,229.00
|
| Rate for Payer: Cash Price |
$16,265.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,301.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,458.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,458.00
|
| Rate for Payer: Galaxy Health WC |
$30,723.25
|
| Rate for Payer: Global Benefits Group Commercial |
$21,687.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,952.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,325.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,674.80
|
| Rate for Payer: Multiplan Commercial |
$28,916.00
|
| Rate for Payer: Networks By Design Commercial |
$23,494.25
|
| Rate for Payer: Prime Health Services Commercial |
$30,723.25
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
IP
|
$9,185.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,837.00 |
| Max. Negotiated Rate |
$7,807.25 |
| Rate for Payer: Adventist Health Commercial |
$1,837.00
|
| Rate for Payer: Cash Price |
$4,133.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,429.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,674.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,674.00
|
| Rate for Payer: Galaxy Health WC |
$7,807.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,511.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,832.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,419.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,204.40
|
| Rate for Payer: Multiplan Commercial |
$7,348.00
|
| Rate for Payer: Networks By Design Commercial |
$5,970.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,807.25
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
OP
|
$9,185.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,837.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,837.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,807.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,051.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,888.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$4,133.25
|
| Rate for Payer: Cash Price |
$4,133.25
|
| Rate for Payer: Cigna of CA HMO |
$5,970.25
|
| Rate for Payer: Cigna of CA PPO |
$6,796.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,807.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,807.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,807.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,429.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,674.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,674.00
|
| Rate for Payer: Galaxy Health WC |
$7,807.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,511.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,832.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,334.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,419.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,204.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,429.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,429.50
|
| Rate for Payer: Multiplan Commercial |
$7,348.00
|
| Rate for Payer: Networks By Design Commercial |
$5,970.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,807.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,511.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,511.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,592.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$7,807.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,807.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7,807.25
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
OP
|
$37,952.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$32,259.20 |
| Rate for Payer: Adventist Health Commercial |
$7,590.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,783.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,259.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,873.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,464.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: Cigna of CA HMO |
$24,289.28
|
| Rate for Payer: Cigna of CA PPO |
$28,084.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,259.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,259.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,259.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,566.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$15,180.80
|
| Rate for Payer: Galaxy Health WC |
$32,259.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,771.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,099.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,776.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,391.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,108.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,566.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,566.40
|
| Rate for Payer: Multiplan Commercial |
$30,361.60
|
| Rate for Payer: Networks By Design Commercial |
$24,668.80
|
| Rate for Payer: Prime Health Services Commercial |
$32,259.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,771.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,771.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,259.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,259.20
|
| Rate for Payer: Vantage Medical Group Senior |
$32,259.20
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
IP
|
$37,952.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,590.40 |
| Max. Negotiated Rate |
$32,259.20 |
| Rate for Payer: Adventist Health Commercial |
$7,590.40
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,566.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$15,180.80
|
| Rate for Payer: Galaxy Health WC |
$32,259.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,771.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,099.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,391.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,108.48
|
| Rate for Payer: Multiplan Commercial |
$30,361.60
|
| Rate for Payer: Networks By Design Commercial |
$24,668.80
|
| Rate for Payer: Prime Health Services Commercial |
$32,259.20
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
IP
|
$22,965.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,593.00 |
| Max. Negotiated Rate |
$19,520.25 |
| Rate for Payer: Adventist Health Commercial |
$4,593.00
|
| Rate for Payer: Cash Price |
$10,334.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,075.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,186.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,186.00
|
| Rate for Payer: Galaxy Health WC |
$19,520.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,779.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,582.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,549.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,511.60
|
| Rate for Payer: Multiplan Commercial |
$18,372.00
|
| Rate for Payer: Networks By Design Commercial |
$14,927.25
|
| Rate for Payer: Prime Health Services Commercial |
$19,520.25
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$22,965.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$909.18 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,593.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,520.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,630.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,223.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Cash Price |
$10,334.25
|
| Rate for Payer: Cash Price |
$10,334.25
|
| Rate for Payer: Cash Price |
$10,334.25
|
| Rate for Payer: Cigna of CA HMO |
$14,927.25
|
| Rate for Payer: Cigna of CA PPO |
$16,994.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,520.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,520.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,520.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,075.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,186.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,186.00
|
| Rate for Payer: Galaxy Health WC |
$19,520.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,779.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$909.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,582.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,028.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,549.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,511.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,075.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,075.50
|
| Rate for Payer: Multiplan Commercial |
$18,372.00
|
| Rate for Payer: Networks By Design Commercial |
$14,927.25
|
| Rate for Payer: Prime Health Services Commercial |
$19,520.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,779.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,779.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,482.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$19,520.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,520.25
|
| Rate for Payer: Vantage Medical Group Senior |
$19,520.25
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$34,338.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,867.60 |
| Max. Negotiated Rate |
$29,187.30 |
| Rate for Payer: Adventist Health Commercial |
$6,867.60
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,036.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,735.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13,735.20
|
| Rate for Payer: Galaxy Health WC |
$29,187.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20,602.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,804.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,259.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,241.12
|
| Rate for Payer: Multiplan Commercial |
$27,470.40
|
| Rate for Payer: Networks By Design Commercial |
$22,319.70
|
| Rate for Payer: Prime Health Services Commercial |
$29,187.30
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$34,338.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$29,187.30 |
| Rate for Payer: Adventist Health Commercial |
$6,867.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22,522.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Cigna of CA HMO |
$21,976.32
|
| Rate for Payer: Cigna of CA PPO |
$25,410.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,036.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$29,187.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20,602.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,804.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,464.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,241.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,470.40
|
| Rate for Payer: Networks By Design Commercial |
$22,319.70
|
| Rate for Payer: Prime Health Services Commercial |
$29,187.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,602.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,602.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC PDL TUBE
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.76
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC PDL TUBE
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
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 |
$5,859.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,443.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4,907.76
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,503.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,146.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,354.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,711.20
|
| 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 |
915357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,936.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cigna of CA HMO |
$6,776.00
|
| Rate for Payer: Cigna of CA PPO |
$6,776.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$6,146.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,711.20
|
| 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 |
$6,292.00
|
| 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 |
905357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,936.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cigna of CA HMO |
$6,776.00
|
| Rate for Payer: Cigna of CA PPO |
$6,776.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$6,146.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,711.20
|
| 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 |
$6,292.00
|
| 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 |
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 |
$5,859.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,443.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4,907.76
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,503.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,146.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,354.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,711.20
|
| 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 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 |
$1.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.87
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| 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 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: Vantage Medical Group Senior |
$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 |
$2.63
|
| Rate for Payer: Cash Price |
$1.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.87
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| 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
|
|
|
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 |
$9.63
|
| Rate for Payer: Cash Price |
$6.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.51
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.86
|
| 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 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 |
$6.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.51
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.86
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$677.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Cigna of CA HMO |
$2,370.34
|
| Rate for Payer: Cigna of CA PPO |
$2,370.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,150.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,997.86
|
| 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 |
$2,201.03
|
| 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
|
IP
|
$3,386.20
|
|
|
Service Code
|
CPT L6714
|
| Hospital Charge Code |
905356714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$677.24 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$677.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Cigna of CA HMO |
$2,370.34
|
| Rate for Payer: Cigna of CA PPO |
$2,370.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,150.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,997.86
|
| 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 |
$2,201.03
|
| 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 |
$2,049.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2,603.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,716.80
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Cash Price |
$1,523.79
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,574.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,150.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,781.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,997.86
|
| 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
|
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 |
$2,049.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2,603.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,716.80
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Cash Price |
$1,523.79
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,574.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,150.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,781.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,997.86
|
| 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
|
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 |
$2,087.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,651.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.29
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cash Price |
$1,551.74
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,473.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,189.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,666.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,034.50
|
| 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
|
|
