|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$18,971.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$930.83 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,794.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,125.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,434.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,228.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$8,536.95
|
| Rate for Payer: Cash Price |
$8,536.95
|
| Rate for Payer: Cash Price |
$8,536.95
|
| Rate for Payer: Central Health Plan Commercial |
$15,176.80
|
| Rate for Payer: Cigna of CA HMO |
$12,331.15
|
| Rate for Payer: Cigna of CA PPO |
$14,038.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,125.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,125.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,125.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,588.40
|
| Rate for Payer: Galaxy Health WC |
$16,125.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,382.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,073.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$930.83
|
| Rate for Payer: InnovAge PACE Commercial |
$9,485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,743.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,794.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,279.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,279.70
|
| Rate for Payer: Multiplan Commercial |
$14,228.25
|
| Rate for Payer: Networks By Design Commercial |
$12,331.15
|
| Rate for Payer: Prime Health Services Commercial |
$16,125.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,588.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,382.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,382.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,125.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,125.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16,125.35
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$33,373.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,674.60 |
| Max. Negotiated Rate |
$30,035.70 |
| Rate for Payer: Adventist Health Commercial |
$6,674.60
|
| Rate for Payer: Cash Price |
$15,017.85
|
| Rate for Payer: Central Health Plan Commercial |
$26,698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,349.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13,349.20
|
| Rate for Payer: Galaxy Health WC |
$28,367.05
|
| Rate for Payer: Global Benefits Group Commercial |
$20,023.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,035.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,259.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,715.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,657.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.60
|
| Rate for Payer: Multiplan Commercial |
$25,029.75
|
| Rate for Payer: Networks By Design Commercial |
$21,692.45
|
| Rate for Payer: Prime Health Services Commercial |
$28,367.05
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$33,373.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$30,035.70 |
| Rate for Payer: Adventist Health Commercial |
$6,674.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$15,017.85
|
| Rate for Payer: Cash Price |
$15,017.85
|
| Rate for Payer: Cash Price |
$15,017.85
|
| Rate for Payer: Central Health Plan Commercial |
$26,698.40
|
| Rate for Payer: Cigna of CA HMO |
$21,358.72
|
| Rate for Payer: Cigna of CA PPO |
$24,696.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$28,367.05
|
| Rate for Payer: Global Benefits Group Commercial |
$20,023.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,035.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,259.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,715.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$25,029.75
|
| Rate for Payer: Networks By Design Commercial |
$21,692.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$28,367.05
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,023.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,023.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$28,367.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$25,530.30 |
| Rate for Payer: Adventist Health Commercial |
$5,673.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$12,765.15
|
| Rate for Payer: Cash Price |
$12,765.15
|
| Rate for Payer: Cash Price |
$12,765.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,693.60
|
| Rate for Payer: Cigna of CA HMO |
$18,154.88
|
| Rate for Payer: Cigna of CA PPO |
$20,991.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$24,111.95
|
| Rate for Payer: Global Benefits Group Commercial |
$17,020.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,530.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,920.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,807.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,673.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$21,275.25
|
| Rate for Payer: Networks By Design Commercial |
$18,438.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$24,111.95
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,020.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,020.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$28,367.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5,673.40 |
| Max. Negotiated Rate |
$25,530.30 |
| Rate for Payer: Adventist Health Commercial |
$5,673.40
|
| Rate for Payer: Cash Price |
$12,765.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,693.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,346.80
|
| Rate for Payer: Galaxy Health WC |
$24,111.95
|
| Rate for Payer: Global Benefits Group Commercial |
$17,020.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,530.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,920.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,807.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,559.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,673.40
|
| Rate for Payer: Multiplan Commercial |
$21,275.25
|
| Rate for Payer: Networks By Design Commercial |
$18,438.55
|
| Rate for Payer: Prime Health Services Commercial |
$24,111.95
|
|
|
HC PDL TUBE
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC PDL TUBE
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$128.31
|
| Rate for Payer: Blue Shield of California EPN |
$83.79
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC 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 |
$5,685.06
|
| Rate for Payer: Blue Shield of California Commercial |
$7,482.64
|
| 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: 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: InnovAge PACE Commercial |
$4,840.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,354.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,991.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,968.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,776.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,776.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| 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 |
915357008
|
|
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 |
$7,482.64
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,688.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,991.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$5,685.06
|
| Rate for Payer: Blue Shield of California Commercial |
$7,482.64
|
| 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: 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: InnovAge PACE Commercial |
$4,840.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,354.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,991.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,968.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,776.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,776.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| 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 |
$7,482.64
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,688.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,991.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 PEDIAVASCULAR GUIDEWIRE SW30
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC PEDIAVASCULAR GUIDEWIRE SW30
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.44
|
| Rate for Payer: Blue Shield of California Commercial |
$171.08
|
| Rate for Payer: Blue Shield of California EPN |
$111.72
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: InnovAge PACE Commercial |
$140.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Riverside University Health System MISP |
$112.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC PEDIAVASCULAR MONGOOSE 4.0 PIG
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.49
|
| Rate for Payer: Blue Shield of California Commercial |
$178.41
|
| Rate for Payer: Blue Shield of California EPN |
$116.51
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: Cigna of CA HMO |
$186.88
|
| Rate for Payer: Cigna of CA PPO |
$216.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: InnovAge PACE Commercial |
$146.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Riverside University Health System MISP |
$116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.00
|
| Rate for Payer: United Healthcare All Other HMO |
$146.00
|
| Rate for Payer: United Healthcare HMO Rider |
$146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC PEDIAVASCULAR MONGOOSE 4.0 PIG
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
|
|
HC PEDS PORT ACCESS KIT
|
Facility
|
OP
|
$4.10
|
|
| Hospital Charge Code |
901698559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| 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 |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| 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: 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: InnovAge PACE Commercial |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| 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 |
$8.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9.17
|
| 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: 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: InnovAge PACE Commercial |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$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 |
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 |
$2,617.53
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,258.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,290.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,096.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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: Adventist Health Commercial |
$677.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,617.53
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,258.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,290.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,096.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
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 |
$1,988.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,617.53
|
| 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: 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: InnovAge PACE Commercial |
$1,693.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,258.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,096.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,388.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,370.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,370.34
|
| Rate for Payer: Multiplan Commercial |
$2,539.65
|
| 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
|
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 |
$1,988.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,617.53
|
| 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: 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: InnovAge PACE Commercial |
$1,693.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,258.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,096.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,388.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,370.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,370.34
|
| Rate for Payer: Multiplan Commercial |
$2,539.65
|
| 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
|
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 |
$2,025.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,665.54
|
| 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: 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: InnovAge PACE Commercial |
$1,724.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,300.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,134.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.80
|
| 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 |
$2,586.22
|
| 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
|
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 |
$2,025.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,665.54
|
| 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: 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: InnovAge PACE Commercial |
$1,724.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,300.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,134.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.80
|
| 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 |
$2,586.22
|
| 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
|
|
