|
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
|
|
|
HC AE/ED IPOP CAST CHANGE
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
CPT L6388
|
| Hospital Charge Code |
905356388
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cigna of CA HMO |
$613.90
|
| Rate for Payer: Cigna of CA PPO |
$613.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.80
|
| Rate for Payer: EPIC Health Plan Senior |
$350.80
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.48
|
| Rate for Payer: Multiplan Commercial |
$701.60
|
| Rate for Payer: Networks By Design Commercial |
$438.50
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$329.14
|
| Rate for Payer: United Healthcare All Other HMO |
$320.37
|
| Rate for Payer: United Healthcare HMO Rider |
$313.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.22
|
|
|
HC AE/ED IPOP CAST CHANGE
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT L6388
|
| Hospital Charge Code |
905356388
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.48 |
| Max. Negotiated Rate |
$745.45 |
| Rate for Payer: Adventist Health Commercial |
$359.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$745.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$482.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$657.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.96
|
| Rate for Payer: Blue Shield of California Commercial |
$647.23
|
| Rate for Payer: Blue Shield of California EPN |
$426.22
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cigna of CA HMO |
$613.90
|
| Rate for Payer: Cigna of CA PPO |
$613.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$745.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$745.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$745.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.80
|
| Rate for Payer: EPIC Health Plan Senior |
$350.80
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$390.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$613.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$613.90
|
| Rate for Payer: Multiplan Commercial |
$701.60
|
| Rate for Payer: Networks By Design Commercial |
$438.50
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$329.14
|
| Rate for Payer: United Healthcare All Other HMO |
$320.37
|
| Rate for Payer: United Healthcare HMO Rider |
$313.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$745.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$745.45
|
| Rate for Payer: Vantage Medical Group Senior |
$745.45
|
|
|
HC AE/ED IPOP CAST CHANGE
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
CPT L6388
|
| Hospital Charge Code |
915356388
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cigna of CA HMO |
$613.90
|
| Rate for Payer: Cigna of CA PPO |
$613.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.80
|
| Rate for Payer: EPIC Health Plan Senior |
$350.80
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.48
|
| Rate for Payer: Multiplan Commercial |
$701.60
|
| Rate for Payer: Networks By Design Commercial |
$438.50
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$329.14
|
| Rate for Payer: United Healthcare All Other HMO |
$320.37
|
| Rate for Payer: United Healthcare HMO Rider |
$313.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.22
|
|
|
HC AE/ED IPOP CAST CHANGE
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT L6388
|
| Hospital Charge Code |
915356388
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.48 |
| Max. Negotiated Rate |
$745.45 |
| Rate for Payer: Adventist Health Commercial |
$359.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$745.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$482.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$657.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.96
|
| Rate for Payer: Blue Shield of California Commercial |
$647.23
|
| Rate for Payer: Blue Shield of California EPN |
$426.22
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cigna of CA HMO |
$613.90
|
| Rate for Payer: Cigna of CA PPO |
$613.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$745.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$745.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$745.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.80
|
| Rate for Payer: EPIC Health Plan Senior |
$350.80
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$390.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$613.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$613.90
|
| Rate for Payer: Multiplan Commercial |
$701.60
|
| Rate for Payer: Networks By Design Commercial |
$438.50
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$329.14
|
| Rate for Payer: United Healthcare All Other HMO |
$320.37
|
| Rate for Payer: United Healthcare HMO Rider |
$313.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$745.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$745.45
|
| Rate for Payer: Vantage Medical Group Senior |
$745.45
|
|
|
HC AE/ED IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$2,610.00
|
|
|
Service Code
|
CPT L6382
|
| Hospital Charge Code |
915356382
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$626.40 |
| Max. Negotiated Rate |
$2,218.50 |
| Rate for Payer: Adventist Health Commercial |
$1,070.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,435.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,957.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,511.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,926.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,268.46
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cigna of CA HMO |
$1,827.00
|
| Rate for Payer: Cigna of CA PPO |
$1,827.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,218.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,108.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,254.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,615.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,827.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,827.00
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: Networks By Design Commercial |
$1,305.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,566.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,566.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.53
|
| Rate for Payer: United Healthcare All Other HMO |
$953.43
|
| Rate for Payer: United Healthcare HMO Rider |
$932.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,218.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,218.50
|
|
|
HC AE/ED IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$2,610.00
|
|
|
Service Code
|
CPT L6382
|
| Hospital Charge Code |
905356382
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$522.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cigna of CA HMO |
$1,827.00
|
| Rate for Payer: Cigna of CA PPO |
$1,827.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$994.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,615.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.40
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: Networks By Design Commercial |
$1,305.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.53
|
| Rate for Payer: United Healthcare All Other HMO |
$953.43
|
| Rate for Payer: United Healthcare HMO Rider |
$932.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.77
|
|
|
HC AE/ED IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$2,610.00
|
|
|
Service Code
|
CPT L6382
|
| Hospital Charge Code |
905356382
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$626.40 |
| Max. Negotiated Rate |
$2,218.50 |
| Rate for Payer: Adventist Health Commercial |
$1,070.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,435.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,957.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,511.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,926.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,268.46
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cigna of CA HMO |
$1,827.00
|
| Rate for Payer: Cigna of CA PPO |
$1,827.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,218.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,108.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,254.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,615.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,827.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,827.00
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: Networks By Design Commercial |
$1,305.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,566.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,566.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.53
|
| Rate for Payer: United Healthcare All Other HMO |
$953.43
|
| Rate for Payer: United Healthcare HMO Rider |
$932.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,218.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,218.50
|
|
|
HC AE/ED IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$2,610.00
|
|
|
Service Code
|
CPT L6382
|
| Hospital Charge Code |
915356382
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$522.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cigna of CA HMO |
$1,827.00
|
| Rate for Payer: Cigna of CA PPO |
$1,827.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$994.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,615.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.40
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: Networks By Design Commercial |
$1,305.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.53
|
| Rate for Payer: United Healthcare All Other HMO |
$953.43
|
| Rate for Payer: United Healthcare HMO Rider |
$932.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.77
|
|
|
HC AE/ED PREP MOLDED TO MODEL
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
CPT L6584
|
| Hospital Charge Code |
905356584
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$277.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$277.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna of CA HMO |
$971.60
|
| Rate for Payer: Cigna of CA PPO |
$971.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$555.20
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$859.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.12
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: Networks By Design Commercial |
$694.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$520.92
|
| Rate for Payer: United Healthcare All Other HMO |
$507.04
|
| Rate for Payer: United Healthcare HMO Rider |
$496.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$454.57
|
|
|
HC AE/ED PREP MOLDED TO MODEL
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
CPT L6584
|
| Hospital Charge Code |
905356584
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$333.12 |
| Max. Negotiated Rate |
$2,210.29 |
| Rate for Payer: Adventist Health Commercial |
$569.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,179.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,041.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$803.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,024.34
|
| Rate for Payer: Blue Shield of California EPN |
$674.57
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna of CA HMO |
$971.60
|
| Rate for Payer: Cigna of CA PPO |
$971.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,179.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,179.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,179.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$555.20
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,954.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,210.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$859.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$971.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$971.60
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: Networks By Design Commercial |
$694.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$832.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$832.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$520.92
|
| Rate for Payer: United Healthcare All Other HMO |
$507.04
|
| Rate for Payer: United Healthcare HMO Rider |
$496.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$454.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,179.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,179.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,179.80
|
|
|
HC AE/ED PREP MOLDED TO MODEL
|
Facility
|
IP
|
$4,156.00
|
|
|
Service Code
|
CPT L6584
|
| Hospital Charge Code |
915356584
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$831.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,870.20
|
| Rate for Payer: Cash Price |
$1,870.20
|
| Rate for Payer: Cigna of CA HMO |
$2,909.20
|
| Rate for Payer: Cigna of CA PPO |
$2,909.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.40
|
| Rate for Payer: Galaxy Health WC |
$3,532.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,772.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,572.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.44
|
| Rate for Payer: Multiplan Commercial |
$3,324.80
|
| Rate for Payer: Networks By Design Commercial |
$2,078.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,532.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,361.09
|
|
|
HC AE/ED PREP MOLDED TO MODEL
|
Facility
|
OP
|
$4,156.00
|
|
|
Service Code
|
CPT L6584
|
| Hospital Charge Code |
915356584
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$997.44 |
| Max. Negotiated Rate |
$3,532.60 |
| Rate for Payer: Adventist Health Commercial |
$1,703.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,532.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,117.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,407.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3,067.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,019.82
|
| Rate for Payer: Cash Price |
$1,870.20
|
| Rate for Payer: Cash Price |
$1,870.20
|
| Rate for Payer: Cigna of CA HMO |
$2,909.20
|
| Rate for Payer: Cigna of CA PPO |
$2,909.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,532.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,532.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,532.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.40
|
| Rate for Payer: Galaxy Health WC |
$3,532.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,954.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,772.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,210.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,572.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,909.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,909.20
|
| Rate for Payer: Multiplan Commercial |
$3,324.80
|
| Rate for Payer: Networks By Design Commercial |
$2,078.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,532.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,361.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,532.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,532.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,532.60
|
|
|
HC AE/ED PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$2,270.00
|
|
|
Service Code
|
CPT L6586
|
| Hospital Charge Code |
905356586
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$454.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cigna of CA HMO |
$1,589.00
|
| Rate for Payer: Cigna of CA PPO |
$1,589.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Senior |
$908.00
|
| Rate for Payer: Galaxy Health WC |
$1,929.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,514.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,405.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.80
|
| Rate for Payer: Multiplan Commercial |
$1,816.00
|
| Rate for Payer: Networks By Design Commercial |
$1,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,929.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.93
|
| Rate for Payer: United Healthcare All Other HMO |
$829.23
|
| Rate for Payer: United Healthcare HMO Rider |
$811.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.42
|
|
|
HC AE/ED PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$2,270.00
|
|
|
Service Code
|
CPT L6586
|
| Hospital Charge Code |
915356586
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$544.80 |
| Max. Negotiated Rate |
$1,930.67 |
| Rate for Payer: Adventist Health Commercial |
$930.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,248.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,702.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,314.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,675.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,103.22
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cigna of CA HMO |
$1,589.00
|
| Rate for Payer: Cigna of CA PPO |
$1,589.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,929.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,929.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Senior |
$908.00
|
| Rate for Payer: Galaxy Health WC |
$1,929.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,707.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,514.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,930.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,405.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,589.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,589.00
|
| Rate for Payer: Multiplan Commercial |
$1,816.00
|
| Rate for Payer: Networks By Design Commercial |
$1,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,929.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,362.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,362.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.93
|
| Rate for Payer: United Healthcare All Other HMO |
$829.23
|
| Rate for Payer: United Healthcare HMO Rider |
$811.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,929.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,929.50
|
|
|
HC AE/ED PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$2,270.00
|
|
|
Service Code
|
CPT L6586
|
| Hospital Charge Code |
915356586
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$454.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cigna of CA HMO |
$1,589.00
|
| Rate for Payer: Cigna of CA PPO |
$1,589.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Senior |
$908.00
|
| Rate for Payer: Galaxy Health WC |
$1,929.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,514.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,405.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.80
|
| Rate for Payer: Multiplan Commercial |
$1,816.00
|
| Rate for Payer: Networks By Design Commercial |
$1,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,929.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.93
|
| Rate for Payer: United Healthcare All Other HMO |
$829.23
|
| Rate for Payer: United Healthcare HMO Rider |
$811.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.42
|
|
|
HC AE/ED PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$2,270.00
|
|
|
Service Code
|
CPT L6586
|
| Hospital Charge Code |
905356586
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$544.80 |
| Max. Negotiated Rate |
$1,930.67 |
| Rate for Payer: Adventist Health Commercial |
$930.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,248.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,702.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,314.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,675.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,103.22
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cigna of CA HMO |
$1,589.00
|
| Rate for Payer: Cigna of CA PPO |
$1,589.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,929.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,929.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Senior |
$908.00
|
| Rate for Payer: Galaxy Health WC |
$1,929.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,707.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,514.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,930.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,405.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,589.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,589.00
|
| Rate for Payer: Multiplan Commercial |
$1,816.00
|
| Rate for Payer: Networks By Design Commercial |
$1,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,929.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,362.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,362.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.93
|
| Rate for Payer: United Healthcare All Other HMO |
$829.23
|
| Rate for Payer: United Healthcare HMO Rider |
$811.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,929.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,929.50
|
|
|
HC AE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$3,898.00
|
|
|
Service Code
|
CPT L6500
|
| Hospital Charge Code |
915356500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$935.52 |
| Max. Negotiated Rate |
$3,917.99 |
| Rate for Payer: Adventist Health Commercial |
$1,598.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,143.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,923.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,257.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,876.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.43
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cigna of CA HMO |
$2,728.60
|
| Rate for Payer: Cigna of CA PPO |
$2,728.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,313.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,313.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,559.20
|
| Rate for Payer: Galaxy Health WC |
$3,313.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,338.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,464.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,599.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,917.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,728.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,728.60
|
| Rate for Payer: Multiplan Commercial |
$3,118.40
|
| Rate for Payer: Networks By Design Commercial |
$1,949.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,313.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,338.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,338.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,423.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,276.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,313.30
|
|
|
HC AE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$3,898.00
|
|
|
Service Code
|
CPT L6500
|
| Hospital Charge Code |
905356500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$779.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$779.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cigna of CA HMO |
$2,728.60
|
| Rate for Payer: Cigna of CA PPO |
$2,728.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,559.20
|
| Rate for Payer: Galaxy Health WC |
$3,313.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,338.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,599.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.52
|
| Rate for Payer: Multiplan Commercial |
$3,118.40
|
| Rate for Payer: Networks By Design Commercial |
$1,949.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,313.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,423.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,276.60
|
|
|
HC AE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$3,898.00
|
|
|
Service Code
|
CPT L6500
|
| Hospital Charge Code |
905356500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$935.52 |
| Max. Negotiated Rate |
$3,917.99 |
| Rate for Payer: Adventist Health Commercial |
$1,598.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,143.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,923.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,257.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,876.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.43
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cigna of CA HMO |
$2,728.60
|
| Rate for Payer: Cigna of CA PPO |
$2,728.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,313.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,313.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,559.20
|
| Rate for Payer: Galaxy Health WC |
$3,313.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,338.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,464.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,599.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,917.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,728.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,728.60
|
| Rate for Payer: Multiplan Commercial |
$3,118.40
|
| Rate for Payer: Networks By Design Commercial |
$1,949.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,313.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,338.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,338.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,423.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,276.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,313.30
|
|
|
HC AE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$3,898.00
|
|
|
Service Code
|
CPT L6500
|
| Hospital Charge Code |
915356500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$779.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$779.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cigna of CA HMO |
$2,728.60
|
| Rate for Payer: Cigna of CA PPO |
$2,728.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,559.20
|
| Rate for Payer: Galaxy Health WC |
$3,313.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,338.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,599.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.52
|
| Rate for Payer: Multiplan Commercial |
$3,118.40
|
| Rate for Payer: Networks By Design Commercial |
$1,949.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,313.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,423.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,276.60
|
|
|
HC AE EXT POWR LOCK ELBW SWTCH CN
|
Facility
|
OP
|
$22,596.00
|
|
|
Service Code
|
CPT L6950
|
| Hospital Charge Code |
915356950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,423.04 |
| Max. Negotiated Rate |
$19,206.60 |
| Rate for Payer: Adventist Health Commercial |
$9,264.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,427.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,947.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,087.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16,675.85
|
| Rate for Payer: Blue Shield of California EPN |
$10,981.66
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cigna of CA HMO |
$15,817.20
|
| Rate for Payer: Cigna of CA PPO |
$15,817.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,206.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,206.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,038.40
|
| Rate for Payer: Galaxy Health WC |
$19,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,557.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,399.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,071.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,367.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,986.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,423.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,817.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,817.20
|
| Rate for Payer: Multiplan Commercial |
$18,076.80
|
| Rate for Payer: Networks By Design Commercial |
$11,298.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,557.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,557.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,480.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8,254.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8,075.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,400.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Senior |
$19,206.60
|
|
|
HC AE EXT POWR LOCK ELBW SWTCH CN
|
Facility
|
IP
|
$22,596.00
|
|
|
Service Code
|
CPT L6950
|
| Hospital Charge Code |
915356950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,519.20 |
| Max. Negotiated Rate |
$19,206.60 |
| Rate for Payer: Adventist Health Commercial |
$4,519.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cigna of CA HMO |
$15,817.20
|
| Rate for Payer: Cigna of CA PPO |
$15,817.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,038.40
|
| Rate for Payer: Galaxy Health WC |
$19,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,557.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,071.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,609.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,986.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,423.04
|
| Rate for Payer: Multiplan Commercial |
$18,076.80
|
| Rate for Payer: Networks By Design Commercial |
$11,298.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,480.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8,254.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8,075.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,400.19
|
|
|
HC AE EXT POWR LOCK ELBW SWTCH CN
|
Facility
|
OP
|
$22,596.00
|
|
|
Service Code
|
CPT L6950
|
| Hospital Charge Code |
905356950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,423.04 |
| Max. Negotiated Rate |
$19,206.60 |
| Rate for Payer: Adventist Health Commercial |
$9,264.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,427.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,947.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,087.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16,675.85
|
| Rate for Payer: Blue Shield of California EPN |
$10,981.66
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cigna of CA HMO |
$15,817.20
|
| Rate for Payer: Cigna of CA PPO |
$15,817.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,206.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,206.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,038.40
|
| Rate for Payer: Galaxy Health WC |
$19,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,557.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,399.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,071.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,367.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,986.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,423.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,817.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,817.20
|
| Rate for Payer: Multiplan Commercial |
$18,076.80
|
| Rate for Payer: Networks By Design Commercial |
$11,298.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,557.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,557.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,480.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8,254.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8,075.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,400.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Senior |
$19,206.60
|
|
|
HC AE EXT POWR LOCK ELBW SWTCH CN
|
Facility
|
IP
|
$22,596.00
|
|
|
Service Code
|
CPT L6950
|
| Hospital Charge Code |
905356950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,519.20 |
| Max. Negotiated Rate |
$19,206.60 |
| Rate for Payer: Adventist Health Commercial |
$4,519.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cigna of CA HMO |
$15,817.20
|
| Rate for Payer: Cigna of CA PPO |
$15,817.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,038.40
|
| Rate for Payer: Galaxy Health WC |
$19,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,557.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,071.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,609.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,986.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,423.04
|
| Rate for Payer: Multiplan Commercial |
$18,076.80
|
| Rate for Payer: Networks By Design Commercial |
$11,298.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,480.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8,254.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8,075.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,400.19
|
|
