|
HC PEDIATRIC ELECTRIC HAND
|
Facility
|
OP
|
$9,680.00
|
|
|
Service Code
|
CPT L7008
|
| Hospital Charge Code |
905357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,170.20 |
| Max. Negotiated Rate |
$8,712.00 |
| 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 |
$5,630.86
|
| Rate for Payer: Blue Shield of California Commercial |
$7,763.36
|
| Rate for Payer: Blue Shield of California EPN |
$4,878.72
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,744.00
|
| 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: Health Management Network EPO/PPO |
$8,712.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,658.07
|
| 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 |
$3,968.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,776.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| Rate for Payer: Networks By Design Commercial |
$4,840.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,228.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,872.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,808.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,808.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,632.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3,536.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3,459.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,170.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,228.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,228.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,228.00
|
|
|
HC PEDIATRIC ELECTRIC HAND
|
Facility
|
IP
|
$9,680.00
|
|
|
Service Code
|
CPT L7008
|
| Hospital Charge Code |
905357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$8,712.00 |
| Rate for Payer: Adventist Health Commercial |
$1,936.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,763.36
|
| Rate for Payer: Blue Shield of California EPN |
$4,878.72
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,744.00
|
| 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: Health Management Network EPO/PPO |
$8,712.00
|
| 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 |
$1,936.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| 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 |
915357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,170.20 |
| Max. Negotiated Rate |
$8,712.00 |
| 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 |
$5,630.86
|
| Rate for Payer: Blue Shield of California Commercial |
$7,763.36
|
| Rate for Payer: Blue Shield of California EPN |
$4,878.72
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,744.00
|
| 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: Health Management Network EPO/PPO |
$8,712.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,658.07
|
| 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 |
$3,968.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,776.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| Rate for Payer: Networks By Design Commercial |
$4,840.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,228.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,872.00
|
| 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 |
$3.69 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| 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: Health Management Network EPO/PPO |
$3.69
|
| 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 |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| 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 |
$3.69 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.49
|
| 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 Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| 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: Health Management Network EPO/PPO |
$3.69
|
| 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 |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Riverside University Health System MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC PEDS 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 |
$13.51 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.01
|
| 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: Health Management Network EPO/PPO |
$13.51
|
| 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 |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.26
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
|
|
HC PEDS URINE COLLCT CATH KIT 8FR
|
Facility
|
OP
|
$15.01
|
|
| Hospital Charge Code |
901698586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.12
|
| 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 Exchange |
$7.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.73
|
| Rate for Payer: Blue Shield of California Commercial |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.01
|
| 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: Health Management Network EPO/PPO |
$13.51
|
| 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 |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$11.26
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
| Rate for Payer: Riverside University Health System MISP |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.76
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC PED TERM DEV, HAND, VOL CLOSE
|
Facility
|
IP
|
$3,386.20
|
|
|
Service Code
|
CPT L6714
|
| Hospital Charge Code |
915356714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$677.24 |
| Max. Negotiated Rate |
$3,047.58 |
| Rate for Payer: United Healthcare HMO Rider |
$1,210.23
|
| Rate for Payer: Adventist Health Commercial |
$677.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,715.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,706.64
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Central Health Plan Commercial |
$2,708.96
|
| 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: Health Management Network EPO/PPO |
$3,047.58
|
| 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 |
$677.24
|
| Rate for Payer: Multiplan Commercial |
$2,539.65
|
| 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 Select/Navigate/Core |
$1,108.98
|
|
|
HC PED TERM DEV, HAND, VOL CLOSE
|
Facility
|
OP
|
$3,386.20
|
|
|
Service Code
|
CPT L6714
|
| Hospital Charge Code |
915356714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,108.98 |
| Max. Negotiated Rate |
$3,047.58 |
| Rate for Payer: Adventist Health Commercial |
$1,388.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,862.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,539.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,969.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,715.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,706.64
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Central Health Plan Commercial |
$2,708.96
|
| 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: Health Management Network EPO/PPO |
$3,047.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,612.31
|
| 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 |
$1,388.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,370.34
|
| Rate for Payer: Multiplan Commercial |
$2,539.65
|
| Rate for Payer: Networks By Design Commercial |
$1,693.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,878.27
|
| Rate for Payer: Riverside University Health System MISP |
$1,354.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,031.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,031.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,270.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,236.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,108.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,878.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2,878.27
|
|
|
HC PED TERM DEV, HAND, VOL CLOSE
|
Facility
|
IP
|
$3,386.20
|
|
|
Service Code
|
CPT L6714
|
| Hospital Charge Code |
905356714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$677.24 |
| Max. Negotiated Rate |
$3,047.58 |
| Rate for Payer: Adventist Health Commercial |
$677.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,715.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,706.64
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Central Health Plan Commercial |
$2,708.96
|
| 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: Health Management Network EPO/PPO |
$3,047.58
|
| 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 |
$677.24
|
| Rate for Payer: Multiplan Commercial |
$2,539.65
|
| 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 |
$1,108.98 |
| Max. Negotiated Rate |
$3,047.58 |
| Rate for Payer: Adventist Health Commercial |
$1,388.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,862.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,539.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,969.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,715.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,706.64
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Cash Price |
$1,523.79
|
| Rate for Payer: Central Health Plan Commercial |
$2,708.96
|
| 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: Health Management Network EPO/PPO |
$3,047.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,612.31
|
| 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 |
$1,388.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,370.34
|
| Rate for Payer: Multiplan Commercial |
$2,539.65
|
| Rate for Payer: Networks By Design Commercial |
$1,693.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,878.27
|
| Rate for Payer: Riverside University Health System MISP |
$1,354.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,031.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,031.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,270.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1,236.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,210.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,108.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,878.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,878.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2,878.27
|
|
|
HC PED TERM DEV, HOOK, VOL CLOSE
|
Facility
|
IP
|
$3,448.30
|
|
|
Service Code
|
CPT L6712
|
| Hospital Charge Code |
915356712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$689.66 |
| Max. Negotiated Rate |
$3,103.47 |
| Rate for Payer: Adventist Health Commercial |
$689.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,765.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,737.94
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Central Health Plan Commercial |
$2,758.64
|
| 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: Health Management Network EPO/PPO |
$3,103.47
|
| 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 |
$689.66
|
| Rate for Payer: Multiplan Commercial |
$2,586.22
|
| 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
|
OP
|
$3,448.30
|
|
|
Service Code
|
CPT L6712
|
| Hospital Charge Code |
915356712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,129.32 |
| Max. Negotiated Rate |
$3,103.47 |
| 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 |
$2,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,765.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,737.94
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Central Health Plan Commercial |
$2,758.64
|
| 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: Health Management Network EPO/PPO |
$3,103.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,508.23
|
| 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 |
$1,413.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,413.81
|
| Rate for Payer: Multiplan Commercial |
$2,586.22
|
| Rate for Payer: Networks By Design Commercial |
$1,724.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,931.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,379.32
|
| 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 |
$3,103.47 |
| Rate for Payer: Adventist Health Commercial |
$689.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,765.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,737.94
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Central Health Plan Commercial |
$2,758.64
|
| 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: Health Management Network EPO/PPO |
$3,103.47
|
| 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 |
$689.66
|
| Rate for Payer: Multiplan Commercial |
$2,586.22
|
| 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
|
OP
|
$3,448.30
|
|
|
Service Code
|
CPT L6712
|
| Hospital Charge Code |
905356712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,129.32 |
| Max. Negotiated Rate |
$3,103.47 |
| 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 |
$2,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,765.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,737.94
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Central Health Plan Commercial |
$2,758.64
|
| 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: Health Management Network EPO/PPO |
$3,103.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,508.23
|
| 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 |
$1,413.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,413.81
|
| Rate for Payer: Multiplan Commercial |
$2,586.22
|
| Rate for Payer: Networks By Design Commercial |
$1,724.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,931.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,379.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,068.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,068.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,294.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1,259.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,232.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,129.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,931.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,931.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,931.05
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
OP
|
$4,352.10
|
|
|
Service Code
|
CPT L6713
|
| Hospital Charge Code |
915356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,425.31 |
| Max. Negotiated Rate |
$3,916.89 |
| 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 |
$2,531.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3,490.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,193.46
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,481.68
|
| 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: Health Management Network EPO/PPO |
$3,916.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,903.56
|
| 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 |
$1,784.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,046.47
|
| Rate for Payer: Multiplan Commercial |
$3,264.07
|
| Rate for Payer: Networks By Design Commercial |
$2,176.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.28
|
| Rate for Payer: Riverside University Health System MISP |
$1,740.84
|
| 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
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
905356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,374.57 |
| Max. Negotiated Rate |
$10,685.57 |
| Rate for Payer: Adventist Health Commercial |
$2,374.57
|
| Rate for Payer: Blue Shield of California Commercial |
$9,522.03
|
| Rate for Payer: Blue Shield of California EPN |
$5,983.92
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Central Health Plan Commercial |
$9,498.28
|
| 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: Health Management Network EPO/PPO |
$10,685.57
|
| 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 |
$2,374.57
|
| Rate for Payer: Multiplan Commercial |
$8,904.64
|
| 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 |
915356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$819.17 |
| Max. Negotiated Rate |
$10,685.57 |
| Rate for Payer: Networks By Design Commercial |
$5,936.43
|
| Rate for Payer: Adventist Health Commercial |
$4,867.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,091.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,530.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,904.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,906.44
|
| Rate for Payer: Blue Shield of California Commercial |
$9,522.03
|
| Rate for Payer: Blue Shield of California EPN |
$5,983.92
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Central Health Plan Commercial |
$9,498.28
|
| 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: Health Management Network EPO/PPO |
$10,685.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$819.17
|
| 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 |
$4,867.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,311.00
|
| Rate for Payer: Multiplan Commercial |
$8,904.64
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| Rate for Payer: Riverside University Health System MISP |
$4,749.14
|
| 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
|
IP
|
$4,352.10
|
|
|
Service Code
|
CPT L6713
|
| Hospital Charge Code |
905356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$870.42 |
| Max. Negotiated Rate |
$3,916.89 |
| Rate for Payer: Adventist Health Commercial |
$870.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,490.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,193.46
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,481.68
|
| 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: Health Management Network EPO/PPO |
$3,916.89
|
| 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 |
$870.42
|
| Rate for Payer: Multiplan Commercial |
$3,264.07
|
| 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 |
915356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,374.57 |
| Max. Negotiated Rate |
$10,685.57 |
| Rate for Payer: Adventist Health Commercial |
$2,374.57
|
| Rate for Payer: Blue Shield of California Commercial |
$9,522.03
|
| Rate for Payer: Blue Shield of California EPN |
$5,983.92
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Central Health Plan Commercial |
$9,498.28
|
| 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: Health Management Network EPO/PPO |
$10,685.57
|
| 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 |
$2,374.57
|
| Rate for Payer: Multiplan Commercial |
$8,904.64
|
| 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 |
$819.17 |
| Max. Negotiated Rate |
$10,685.57 |
| Rate for Payer: Adventist Health Commercial |
$4,867.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,091.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,530.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,904.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,906.44
|
| Rate for Payer: Blue Shield of California Commercial |
$9,522.03
|
| Rate for Payer: Blue Shield of California EPN |
$5,983.92
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Cash Price |
$5,342.78
|
| Rate for Payer: Central Health Plan Commercial |
$9,498.28
|
| 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: Health Management Network EPO/PPO |
$10,685.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$819.17
|
| 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 |
$4,867.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,311.00
|
| Rate for Payer: Multiplan Commercial |
$8,904.64
|
| Rate for Payer: Networks By Design Commercial |
$5,936.43
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| Rate for Payer: Riverside University Health System MISP |
$4,749.14
|
| 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 |
$1,425.31 |
| Max. Negotiated Rate |
$3,916.89 |
| 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 |
$2,531.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3,490.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,193.46
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,481.68
|
| 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: Health Management Network EPO/PPO |
$3,916.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,903.56
|
| 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 |
$1,784.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,046.47
|
| Rate for Payer: Multiplan Commercial |
$3,264.07
|
| Rate for Payer: Networks By Design Commercial |
$2,176.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.28
|
| Rate for Payer: Riverside University Health System MISP |
$1,740.84
|
| 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 |
$3,916.89 |
| Rate for Payer: Cash Price |
$1,958.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,481.68
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: Adventist Health Commercial |
$870.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,490.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,193.46
|
| 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: Health Management Network EPO/PPO |
$3,916.89
|
| 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 |
$870.42
|
| Rate for Payer: Multiplan Commercial |
$3,264.07
|
| 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 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 |
$221.40 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| 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: Health Management Network EPO/PPO |
$221.40
|
| 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 |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
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 |
$235.49 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| 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 Exchange |
$119.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.10
|
| Rate for Payer: Blue Shield of California Commercial |
$155.96
|
| Rate for Payer: Blue Shield of California EPN |
$98.15
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| 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: Health Management Network EPO/PPO |
$221.40
|
| 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 |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| 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
|
|
