|
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: Galaxy Health WC |
$4,878.15
|
| Rate for Payer: Adventist Health Commercial |
$1,147.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,808.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,682.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3,661.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,416.12
|
| 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 |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,017.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1,831.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3,443.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,730.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$365.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,644.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$413.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,331.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,098.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,231.27
|
| 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 |
$1,665.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,017.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,644.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,386.01
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,657.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,398.40
|
| 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 |
$3,744.00
|
| 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
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,657.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,398.40
|
| 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 |
$3,744.00
|
| 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: 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 |
$3,486.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,429.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,920.32
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,868.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,657.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,398.40
|
| 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
|
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: Vantage Medical Group Senior |
$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 |
$3,486.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,429.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,920.32
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,868.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,657.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,398.40
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,175.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,730.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,466.25
|
| 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 |
$3,818.75
|
| 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 |
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 |
$3,556.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,517.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,978.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,947.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,730.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,463.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,466.25
|
| 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
|
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 |
$3,556.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,517.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,978.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,947.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,730.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,463.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,466.25
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,175.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,730.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,466.25
|
| 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 |
$3,818.75
|
| 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 |
$54.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$54.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$54.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.22
|
| 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 |
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 |
$4,463.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5,670.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,738.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,971.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,682.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,229.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,350.66
|
| 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 |
915356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,474.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,474.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,682.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,350.66
|
| 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 |
$4,793.10
|
| 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 |
905356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,474.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,474.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,682.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,350.66
|
| 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 |
$4,793.10
|
| 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 |
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 |
$4,463.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5,670.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,738.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,971.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,682.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,229.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,350.66
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$512.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$476.13
|
| 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 |
$524.55
|
| 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
|
IP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
915356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$512.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$476.13
|
| 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 |
$524.55
|
| 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 |
$488.48
|
| Rate for Payer: Blue Shield of California Commercial |
$620.58
|
| Rate for Payer: Blue Shield of California Commercial |
$409.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$489.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$512.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$476.13
|
| 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
|
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 |
$488.48
|
| Rate for Payer: Blue Shield of California Commercial |
$620.58
|
| Rate for Payer: Blue Shield of California Commercial |
$409.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$489.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$512.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$476.13
|
| 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 |
905356682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| 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 |
$604.50
|
| 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 |
915356682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| 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 |
$604.50
|
| 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: Vantage Medical Group Senior |
$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 |
$562.93
|
| Rate for Payer: Blue Shield of California Commercial |
$715.17
|
| Rate for Payer: Blue Shield of California Commercial |
$471.51
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| 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
|
|
|
HC AE/ED ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6682
|
| Hospital Charge Code |
905356682
|
|
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 |
$562.93
|
| Rate for Payer: Blue Shield of California Commercial |
$715.17
|
| Rate for Payer: Blue Shield of California Commercial |
$471.51
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| 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
|
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 |
$530.85
|
| Rate for Payer: Blue Shield of California Commercial |
$674.41
|
| Rate for Payer: Blue Shield of California Commercial |
$444.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$390.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$556.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$441.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$517.43
|
| 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
|
|
