|
HC ADM SARSCOV2 VAC JJ BOOSTER AD26 .5ML
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 0034A
|
| Hospital Charge Code |
949001319
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 VAC JJ BOOSTER AD26 .5ML
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 0034A
|
| Hospital Charge Code |
949001319
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADRENAL SCAN
|
Facility
|
IP
|
$5,739.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,147.80 |
| Max. Negotiated Rate |
$4,878.15 |
| Rate for Payer: Adventist Health Commercial |
$1,147.80
|
| Rate for Payer: Cash Price |
$2,582.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,295.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,295.60
|
| Rate for Payer: Galaxy Health WC |
$4,878.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,443.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,827.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,186.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,552.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.36
|
| Rate for Payer: Multiplan Commercial |
$4,591.20
|
| Rate for Payer: Networks By Design Commercial |
$3,730.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,878.15
|
|
|
HC ADRENAL SCAN
|
Facility
|
OP
|
$5,739.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$365.94 |
| Max. Negotiated Rate |
$4,878.15 |
| Rate for Payer: Adventist Health Commercial |
$1,147.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,764.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,524.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3,512.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,318.56
|
| Rate for Payer: Cash Price |
$2,582.55
|
| Rate for Payer: Cash Price |
$2,582.55
|
| Rate for Payer: Cigna of CA HMO |
$3,672.96
|
| Rate for Payer: Cigna of CA PPO |
$4,246.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$4,878.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,443.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$365.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,827.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$4,591.20
|
| Rate for Payer: Networks By Design Commercial |
$3,730.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,878.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,443.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,443.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,519.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,519.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2,519.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,519.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC ADULT ELECTRIC HAND
|
Facility
|
OP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
905357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,382.40 |
| Max. Negotiated Rate |
$4,896.00 |
| Rate for Payer: Adventist Health Commercial |
$2,361.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,168.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,336.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4,250.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,799.36
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,896.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,868.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,565.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,032.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,032.00
|
| Rate for Payer: Multiplan Commercial |
$4,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,456.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,161.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2,104.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,058.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,886.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,896.00
|
|
|
HC ADULT ELECTRIC HAND
|
Facility
|
IP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
905357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,152.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,194.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,565.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.40
|
| Rate for Payer: Multiplan Commercial |
$4,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,161.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2,104.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,058.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,886.40
|
|
|
HC ADULT ELECTRIC HAND
|
Facility
|
OP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
915357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,382.40 |
| Max. Negotiated Rate |
$4,896.00 |
| Rate for Payer: United Healthcare HMO Rider |
$2,058.62
|
| Rate for Payer: Adventist Health Commercial |
$2,361.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,168.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,336.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4,250.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,799.36
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,896.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,868.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,565.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,032.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,032.00
|
| Rate for Payer: Multiplan Commercial |
$4,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,456.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,161.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2,104.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,886.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,896.00
|
|
|
HC ADULT ELECTRIC HAND
|
Facility
|
IP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
915357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,152.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,194.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,565.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.40
|
| Rate for Payer: Multiplan Commercial |
$4,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,161.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2,104.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,058.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,886.40
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
OP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
915357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,993.75 |
| Rate for Payer: Adventist Health Commercial |
$2,408.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,231.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,406.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,402.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,335.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,855.25
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cigna of CA HMO |
$4,112.50
|
| Rate for Payer: Cigna of CA PPO |
$4,112.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,993.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,993.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,350.00
|
| Rate for Payer: Galaxy Health WC |
$4,993.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,947.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,463.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,112.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,112.50
|
| Rate for Payer: Multiplan Commercial |
$4,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,993.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,204.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,146.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,099.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,924.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,993.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,993.75
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
IP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
905357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,175.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,175.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cigna of CA HMO |
$4,112.50
|
| Rate for Payer: Cigna of CA PPO |
$4,112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,350.00
|
| Rate for Payer: Galaxy Health WC |
$4,993.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,238.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Multiplan Commercial |
$4,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,993.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,204.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,146.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,099.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,924.06
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
OP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
905357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,993.75 |
| Rate for Payer: Adventist Health Commercial |
$2,408.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,231.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,406.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,402.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,335.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,855.25
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cigna of CA HMO |
$4,112.50
|
| Rate for Payer: Cigna of CA PPO |
$4,112.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,993.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,993.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,350.00
|
| Rate for Payer: Galaxy Health WC |
$4,993.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,947.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,463.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,112.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,112.50
|
| Rate for Payer: Multiplan Commercial |
$4,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,993.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,204.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,146.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,099.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,924.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,993.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,993.75
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
IP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
915357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,175.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,175.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cigna of CA HMO |
$4,112.50
|
| Rate for Payer: Cigna of CA PPO |
$4,112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,350.00
|
| Rate for Payer: Galaxy Health WC |
$4,993.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,238.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Multiplan Commercial |
$4,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,993.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,204.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,146.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,099.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,924.06
|
|
|
HC ADULT PICC/CVC DRSNG CHNG KIT
|
Facility
|
OP
|
$85.12
|
|
| Hospital Charge Code |
901698284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$17.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.27
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cigna of CA HMO |
$54.48
|
| Rate for Payer: Cigna of CA PPO |
$62.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.05
|
| Rate for Payer: EPIC Health Plan Senior |
$34.05
|
| Rate for Payer: Galaxy Health WC |
$72.35
|
| Rate for Payer: Global Benefits Group Commercial |
$51.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.58
|
| Rate for Payer: Multiplan Commercial |
$68.10
|
| Rate for Payer: Networks By Design Commercial |
$55.33
|
| Rate for Payer: Prime Health Services Commercial |
$72.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.56
|
| Rate for Payer: United Healthcare All Other HMO |
$42.56
|
| Rate for Payer: United Healthcare HMO Rider |
$42.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.35
|
| Rate for Payer: Vantage Medical Group Senior |
$72.35
|
|
|
HC ADULT PICC/CVC DRSNG CHNG KIT
|
Facility
|
IP
|
$85.12
|
|
| Hospital Charge Code |
901698284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$17.02
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.05
|
| Rate for Payer: EPIC Health Plan Senior |
$34.05
|
| Rate for Payer: Galaxy Health WC |
$72.35
|
| Rate for Payer: Global Benefits Group Commercial |
$51.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.43
|
| Rate for Payer: Multiplan Commercial |
$68.10
|
| Rate for Payer: Networks By Design Commercial |
$55.33
|
| Rate for Payer: Prime Health Services Commercial |
$72.35
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
OP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
905356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,769.76 |
| Max. Negotiated Rate |
$6,267.90 |
| Rate for Payer: Adventist Health Commercial |
$3,023.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,055.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,530.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,271.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5,442.01
|
| Rate for Payer: Blue Shield of California EPN |
$3,583.76
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,267.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,267.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,971.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,229.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,161.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,161.80
|
| Rate for Payer: Multiplan Commercial |
$5,899.20
|
| Rate for Payer: Networks By Design Commercial |
$3,687.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,424.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,424.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,693.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,635.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,414.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,267.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,267.90
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
IP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
905356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,474.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,474.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,809.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.76
|
| Rate for Payer: Multiplan Commercial |
$5,899.20
|
| Rate for Payer: Networks By Design Commercial |
$3,687.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,693.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,635.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,414.99
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
IP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
915356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,474.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,474.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,809.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.76
|
| Rate for Payer: Multiplan Commercial |
$5,899.20
|
| Rate for Payer: Networks By Design Commercial |
$3,687.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,693.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,635.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,414.99
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
OP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
915356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,769.76 |
| Max. Negotiated Rate |
$6,267.90 |
| Rate for Payer: Adventist Health Commercial |
$3,023.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,055.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,530.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,271.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5,442.01
|
| Rate for Payer: Blue Shield of California EPN |
$3,583.76
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,267.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,267.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,971.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,229.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,161.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,161.80
|
| Rate for Payer: Multiplan Commercial |
$5,899.20
|
| Rate for Payer: Networks By Design Commercial |
$3,687.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,424.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,424.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,693.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,635.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,414.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,267.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,267.90
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
905356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.68
|
| Rate for Payer: Multiplan Commercial |
$645.60
|
| Rate for Payer: Networks By Design Commercial |
$403.50
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.87
|
| Rate for Payer: United Healthcare All Other HMO |
$294.80
|
| Rate for Payer: United Healthcare HMO Rider |
$288.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.29
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
905356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.68 |
| Max. Negotiated Rate |
$685.95 |
| Rate for Payer: Adventist Health Commercial |
$330.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$605.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.41
|
| Rate for Payer: Blue Shield of California Commercial |
$595.57
|
| Rate for Payer: Blue Shield of California EPN |
$392.20
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$489.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.90
|
| Rate for Payer: Multiplan Commercial |
$645.60
|
| Rate for Payer: Networks By Design Commercial |
$403.50
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.87
|
| Rate for Payer: United Healthcare All Other HMO |
$294.80
|
| Rate for Payer: United Healthcare HMO Rider |
$288.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.95
|
| Rate for Payer: Vantage Medical Group Senior |
$685.95
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
915356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.68
|
| Rate for Payer: Multiplan Commercial |
$645.60
|
| Rate for Payer: Networks By Design Commercial |
$403.50
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.87
|
| Rate for Payer: United Healthcare All Other HMO |
$294.80
|
| Rate for Payer: United Healthcare HMO Rider |
$288.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.29
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
915356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.68 |
| Max. Negotiated Rate |
$685.95 |
| Rate for Payer: Adventist Health Commercial |
$330.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$605.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.41
|
| Rate for Payer: Blue Shield of California Commercial |
$595.57
|
| Rate for Payer: Blue Shield of California EPN |
$392.20
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$489.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.90
|
| Rate for Payer: Multiplan Commercial |
$645.60
|
| Rate for Payer: Networks By Design Commercial |
$403.50
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.87
|
| Rate for Payer: United Healthcare All Other HMO |
$294.80
|
| Rate for Payer: United Healthcare HMO Rider |
$288.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.95
|
| Rate for Payer: Vantage Medical Group Senior |
$685.95
|
|
|
HC AE/ED ADDITION TEST SOCKET
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT L6682
|
| Hospital Charge Code |
915356682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
|
|
HC AE/ED ADDITION TEST SOCKET
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT L6682
|
| Hospital Charge Code |
905356682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
|
|
HC AE/ED ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6682
|
| Hospital Charge Code |
915356682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.66
|
| Rate for Payer: Blue Shield of California Commercial |
$686.34
|
| Rate for Payer: Blue Shield of California EPN |
$451.98
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
