|
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 |
$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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$689.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,189.67
|
| 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: Multiplan Commercial |
$2,758.64
|
| Rate for Payer: Networks By Design Commercial |
$2,241.39
|
| 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
|
IP
|
$3,448.30
|
|
|
Service Code
|
CPT L6712
|
| Hospital Charge Code |
915356712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$689.66 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$689.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,189.67
|
| 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: Multiplan Commercial |
$2,758.64
|
| Rate for Payer: Networks By Design Commercial |
$2,241.39
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$870.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,763.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,567.74
|
| 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 |
$2,828.86
|
| 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 |
$7,186.64
|
| Rate for Payer: Blue Shield of California Commercial |
$9,130.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6,019.53
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Cash Price |
$5,342.78
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,311.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,539.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$904.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,004.98
|
| 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
|
|
|
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 |
$2,634.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,346.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,206.51
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Cash Price |
$1,958.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,859.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,763.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,102.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,567.74
|
| 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 |
$2,634.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,346.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,206.51
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Cash Price |
$1,958.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,859.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,763.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,102.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,567.74
|
| 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 |
915356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$870.42 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$870.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,763.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,567.74
|
| 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 |
$2,828.86
|
| 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
|
IP
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
905356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,374.57 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,374.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Cigna of CA HMO |
$8,311.00
|
| Rate for Payer: Cigna of CA PPO |
$8,311.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,311.00
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,539.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,004.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,849.48
|
| Rate for Payer: Multiplan Commercial |
$9,498.28
|
| Rate for Payer: Networks By Design Commercial |
$7,717.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| 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
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
IP
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
915356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,374.57 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,374.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Cigna of CA HMO |
$8,311.00
|
| Rate for Payer: Cigna of CA PPO |
$8,311.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,311.00
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,539.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,004.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,849.48
|
| Rate for Payer: Multiplan Commercial |
$9,498.28
|
| Rate for Payer: Networks By Design Commercial |
$7,717.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| 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
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
OP
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
905356711
|
|
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 |
$7,186.64
|
| Rate for Payer: Blue Shield of California Commercial |
$9,130.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6,019.53
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Cash Price |
$5,342.78
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,311.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,539.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$904.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,004.98
|
| 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
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.86
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.00
|
| Rate for Payer: United Healthcare All Other HMO |
$123.00
|
| Rate for Payer: United Healthcare HMO Rider |
$123.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$729.61
|
| Rate for Payer: Blue Shield of California Commercial |
$725.41
|
| Rate for Payer: Blue Shield of California Commercial |
$478.68
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cigna of CA HMO |
$727.68
|
| Rate for Payer: Cigna of CA PPO |
$841.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$682.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$227.40 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
915352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$278.76 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$540.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$989.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$798.39
|
| Rate for Payer: Blue Shield of California Commercial |
$668.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,014.31
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,121.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,121.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.30
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,121.15
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$278.76 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$540.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$989.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$798.39
|
| Rate for Payer: Blue Shield of California Commercial |
$668.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,014.31
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,121.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,121.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.30
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,121.15
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
915352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
915352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
915352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.04 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$326.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$481.82
|
| Rate for Payer: Blue Shield of California Commercial |
$612.12
|
| Rate for Payer: Blue Shield of California Commercial |
$403.57
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$676.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$557.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.04 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$326.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$481.82
|
| Rate for Payer: Blue Shield of California Commercial |
$612.12
|
| Rate for Payer: Blue Shield of California Commercial |
$403.57
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$676.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$557.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
IP
|
$7,672.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,534.40 |
| Max. Negotiated Rate |
$6,521.20 |
| Rate for Payer: Adventist Health Commercial |
$1,534.40
|
| Rate for Payer: Cash Price |
$3,452.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,370.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,068.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,068.80
|
| Rate for Payer: Galaxy Health WC |
$6,521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,603.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,871.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,526.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.28
|
| Rate for Payer: Multiplan Commercial |
$6,137.60
|
| Rate for Payer: Networks By Design Commercial |
$4,986.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,521.20
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$7,672.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$6,869.74 |
| Rate for Payer: Adventist Health Commercial |
$1,534.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,452.40
|
| Rate for Payer: Cash Price |
$3,452.40
|
| Rate for Payer: Cash Price |
$3,452.40
|
| Rate for Payer: Cigna of CA HMO |
$4,910.08
|
| Rate for Payer: Cigna of CA PPO |
$5,677.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,370.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$6,521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,603.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,871.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$6,137.60
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,986.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,521.20
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,603.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,836.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,836.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,836.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
