|
HC BE/WD ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT L6687
|
| Hospital Charge Code |
905356687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna of CA HMO |
$701.40
|
| Rate for Payer: Cigna of CA PPO |
$701.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$620.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.48
|
| Rate for Payer: Multiplan Commercial |
$801.60
|
| Rate for Payer: Networks By Design Commercial |
$501.00
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.05
|
| Rate for Payer: United Healthcare All Other HMO |
$366.03
|
| Rate for Payer: United Healthcare HMO Rider |
$358.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.15
|
|
|
HC BE/WD ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT L6687
|
| Hospital Charge Code |
915356687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna of CA HMO |
$701.40
|
| Rate for Payer: Cigna of CA PPO |
$701.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$620.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.48
|
| Rate for Payer: Multiplan Commercial |
$801.60
|
| Rate for Payer: Networks By Design Commercial |
$501.00
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.05
|
| Rate for Payer: United Healthcare All Other HMO |
$366.03
|
| Rate for Payer: United Healthcare HMO Rider |
$358.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.15
|
|
|
HC BE/WD ADD FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT L6687
|
| Hospital Charge Code |
905356687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.48 |
| Max. Negotiated Rate |
$851.70 |
| Rate for Payer: Adventist Health Commercial |
$410.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$551.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$751.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$580.36
|
| Rate for Payer: Blue Shield of California Commercial |
$739.48
|
| Rate for Payer: Blue Shield of California EPN |
$486.97
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna of CA HMO |
$701.40
|
| Rate for Payer: Cigna of CA PPO |
$701.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$851.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$851.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$620.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$701.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$701.40
|
| Rate for Payer: Multiplan Commercial |
$801.60
|
| Rate for Payer: Networks By Design Commercial |
$501.00
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.05
|
| Rate for Payer: United Healthcare All Other HMO |
$366.03
|
| Rate for Payer: United Healthcare HMO Rider |
$358.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$851.70
|
| Rate for Payer: Vantage Medical Group Senior |
$851.70
|
|
|
HC BE/WD ADDITION TEST SOCKET
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L6680
|
| Hospital Charge Code |
905356680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC BE/WD ADDITION TEST SOCKET
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L6680
|
| Hospital Charge Code |
915356680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.04 |
| Max. Negotiated Rate |
$442.85 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.76
|
| Rate for Payer: Blue Shield of California Commercial |
$384.50
|
| Rate for Payer: Blue Shield of California EPN |
$253.21
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC BE/WD ADDITION TEST SOCKET
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L6680
|
| Hospital Charge Code |
905356680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.04 |
| Max. Negotiated Rate |
$442.85 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.76
|
| Rate for Payer: Blue Shield of California Commercial |
$384.50
|
| Rate for Payer: Blue Shield of California EPN |
$253.21
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC BE/WD ADDITION TEST SOCKET
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L6680
|
| Hospital Charge Code |
915356680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC BE/WD IPOP CAST CHANGE
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L6386
|
| Hospital Charge Code |
905356386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
|
|
HC BE/WD IPOP CAST CHANGE
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L6386
|
| Hospital Charge Code |
905356386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.16 |
| Max. Negotiated Rate |
$730.15 |
| Rate for Payer: Adventist Health Commercial |
$352.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$497.53
|
| Rate for Payer: Blue Shield of California Commercial |
$633.94
|
| Rate for Payer: Blue Shield of California EPN |
$417.47
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.30
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC BE/WD IPOP CAST CHANGE
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L6386
|
| Hospital Charge Code |
915356386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.16 |
| Max. Negotiated Rate |
$730.15 |
| Rate for Payer: Adventist Health Commercial |
$352.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$497.53
|
| Rate for Payer: Blue Shield of California Commercial |
$633.94
|
| Rate for Payer: Blue Shield of California EPN |
$417.47
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.30
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC BE/WD IPOP CAST CHANGE
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L6386
|
| Hospital Charge Code |
915356386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
|
|
HC BE/WD IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$2,075.00
|
|
|
Service Code
|
CPT L6380
|
| Hospital Charge Code |
905356380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$498.00 |
| Max. Negotiated Rate |
$1,763.75 |
| Rate for Payer: Adventist Health Commercial |
$850.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,763.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,556.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,201.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,531.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,008.45
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cigna of CA HMO |
$1,452.50
|
| Rate for Payer: Cigna of CA PPO |
$1,452.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,763.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,763.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,763.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.00
|
| Rate for Payer: EPIC Health Plan Senior |
$830.00
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$997.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,284.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,452.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,452.50
|
| Rate for Payer: Multiplan Commercial |
$1,660.00
|
| Rate for Payer: Networks By Design Commercial |
$1,037.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,245.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,245.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$778.75
|
| Rate for Payer: United Healthcare All Other HMO |
$758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$741.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$679.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,763.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,763.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,763.75
|
|
|
HC BE/WD IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$2,075.00
|
|
|
Service Code
|
CPT L6380
|
| Hospital Charge Code |
905356380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$415.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cigna of CA HMO |
$1,452.50
|
| Rate for Payer: Cigna of CA PPO |
$1,452.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.00
|
| Rate for Payer: EPIC Health Plan Senior |
$830.00
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$790.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,284.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.00
|
| Rate for Payer: Multiplan Commercial |
$1,660.00
|
| Rate for Payer: Networks By Design Commercial |
$1,037.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$778.75
|
| Rate for Payer: United Healthcare All Other HMO |
$758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$741.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$679.56
|
|
|
HC BE/WD IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$2,075.00
|
|
|
Service Code
|
CPT L6380
|
| Hospital Charge Code |
915356380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$498.00 |
| Max. Negotiated Rate |
$1,763.75 |
| Rate for Payer: Adventist Health Commercial |
$850.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,763.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,556.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,201.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,531.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,008.45
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cigna of CA HMO |
$1,452.50
|
| Rate for Payer: Cigna of CA PPO |
$1,452.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,763.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,763.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,763.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.00
|
| Rate for Payer: EPIC Health Plan Senior |
$830.00
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$997.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,284.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,452.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,452.50
|
| Rate for Payer: Multiplan Commercial |
$1,660.00
|
| Rate for Payer: Networks By Design Commercial |
$1,037.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,245.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,245.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$778.75
|
| Rate for Payer: United Healthcare All Other HMO |
$758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$741.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$679.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,763.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,763.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,763.75
|
|
|
HC BE/WD IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$2,075.00
|
|
|
Service Code
|
CPT L6380
|
| Hospital Charge Code |
915356380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$415.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cigna of CA HMO |
$1,452.50
|
| Rate for Payer: Cigna of CA PPO |
$1,452.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.00
|
| Rate for Payer: EPIC Health Plan Senior |
$830.00
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$790.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,284.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.00
|
| Rate for Payer: Multiplan Commercial |
$1,660.00
|
| Rate for Payer: Networks By Design Commercial |
$1,037.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$778.75
|
| Rate for Payer: United Healthcare All Other HMO |
$758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$741.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$679.56
|
|
|
HC BE/WD PREP MOLDED TO MODEL
|
Facility
|
IP
|
$3,324.00
|
|
|
Service Code
|
CPT L6580
|
| Hospital Charge Code |
915356580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$664.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cigna of CA HMO |
$2,326.80
|
| Rate for Payer: Cigna of CA PPO |
$2,326.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,329.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,329.60
|
| Rate for Payer: Galaxy Health WC |
$2,825.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,994.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,057.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.76
|
| Rate for Payer: Multiplan Commercial |
$2,659.20
|
| Rate for Payer: Networks By Design Commercial |
$1,662.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,825.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,247.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,214.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,188.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.61
|
|
|
HC BE/WD PREP MOLDED TO MODEL
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT L6580
|
| Hospital Charge Code |
905356580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$324.48 |
| Max. Negotiated Rate |
$1,564.42 |
| Rate for Payer: Adventist Health Commercial |
$554.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,149.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$743.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,014.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$783.08
|
| Rate for Payer: Blue Shield of California Commercial |
$997.78
|
| Rate for Payer: Blue Shield of California EPN |
$657.07
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna of CA HMO |
$946.40
|
| Rate for Payer: Cigna of CA PPO |
$946.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,149.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,149.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,149.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$540.80
|
| Rate for Payer: Galaxy Health WC |
$1,149.20
|
| Rate for Payer: Global Benefits Group Commercial |
$811.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,383.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$901.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,564.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$836.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$946.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$946.40
|
| Rate for Payer: Multiplan Commercial |
$1,081.60
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.41
|
| Rate for Payer: United Healthcare All Other HMO |
$493.89
|
| Rate for Payer: United Healthcare HMO Rider |
$483.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,149.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,149.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,149.20
|
|
|
HC BE/WD PREP MOLDED TO MODEL
|
Facility
|
OP
|
$3,324.00
|
|
|
Service Code
|
CPT L6580
|
| Hospital Charge Code |
915356580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$797.76 |
| Max. Negotiated Rate |
$2,825.40 |
| Rate for Payer: Adventist Health Commercial |
$1,362.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,825.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,828.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,493.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,925.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,615.46
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cigna of CA HMO |
$2,326.80
|
| Rate for Payer: Cigna of CA PPO |
$2,326.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,825.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,825.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,825.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,329.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,329.60
|
| Rate for Payer: Galaxy Health WC |
$2,825.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,994.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,383.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,564.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,057.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,326.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,326.80
|
| Rate for Payer: Multiplan Commercial |
$2,659.20
|
| Rate for Payer: Networks By Design Commercial |
$1,662.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,825.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,994.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,994.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,247.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,214.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,188.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,825.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,825.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,825.40
|
|
|
HC BE/WD PREP MOLDED TO MODEL
|
Facility
|
IP
|
$1,352.00
|
|
|
Service Code
|
CPT L6580
|
| Hospital Charge Code |
905356580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$270.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna of CA HMO |
$946.40
|
| Rate for Payer: Cigna of CA PPO |
$946.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$540.80
|
| Rate for Payer: Galaxy Health WC |
$1,149.20
|
| Rate for Payer: Global Benefits Group Commercial |
$811.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$901.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$836.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.48
|
| Rate for Payer: Multiplan Commercial |
$1,081.60
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.41
|
| Rate for Payer: United Healthcare All Other HMO |
$493.89
|
| Rate for Payer: United Healthcare HMO Rider |
$483.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.78
|
|
|
HC BE/WD PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT L6582
|
| Hospital Charge Code |
905356582
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$300.72 |
| Max. Negotiated Rate |
$1,234.90 |
| Rate for Payer: Adventist Health Commercial |
$513.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$689.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$939.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$725.74
|
| Rate for Payer: Blue Shield of California Commercial |
$924.71
|
| Rate for Payer: Blue Shield of California EPN |
$608.96
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cigna of CA HMO |
$877.10
|
| Rate for Payer: Cigna of CA PPO |
$877.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,065.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,065.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,065.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.20
|
| Rate for Payer: EPIC Health Plan Senior |
$501.20
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,091.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,234.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.10
|
| Rate for Payer: Multiplan Commercial |
$1,002.40
|
| Rate for Payer: Networks By Design Commercial |
$626.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$751.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$751.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.25
|
| Rate for Payer: United Healthcare All Other HMO |
$457.72
|
| Rate for Payer: United Healthcare HMO Rider |
$447.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$410.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,065.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,065.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,065.05
|
|
|
HC BE/WD PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$2,560.00
|
|
|
Service Code
|
CPT L6582
|
| Hospital Charge Code |
915356582
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$512.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$512.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cigna of CA HMO |
$1,792.00
|
| Rate for Payer: Cigna of CA PPO |
$1,792.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,024.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,024.00
|
| Rate for Payer: Galaxy Health WC |
$2,176.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,536.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$975.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,584.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.40
|
| Rate for Payer: Multiplan Commercial |
$2,048.00
|
| Rate for Payer: Networks By Design Commercial |
$1,280.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,176.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.77
|
| Rate for Payer: United Healthcare All Other HMO |
$935.17
|
| Rate for Payer: United Healthcare HMO Rider |
$914.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$838.40
|
|
|
HC BE/WD PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT L6582
|
| Hospital Charge Code |
905356582
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cigna of CA HMO |
$877.10
|
| Rate for Payer: Cigna of CA PPO |
$877.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.20
|
| Rate for Payer: EPIC Health Plan Senior |
$501.20
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Multiplan Commercial |
$1,002.40
|
| Rate for Payer: Networks By Design Commercial |
$626.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.25
|
| Rate for Payer: United Healthcare All Other HMO |
$457.72
|
| Rate for Payer: United Healthcare HMO Rider |
$447.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$410.36
|
|
|
HC BE/WD PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$2,560.00
|
|
|
Service Code
|
CPT L6582
|
| Hospital Charge Code |
915356582
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$614.40 |
| Max. Negotiated Rate |
$2,176.00 |
| Rate for Payer: Adventist Health Commercial |
$1,049.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,176.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,408.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,920.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,482.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,889.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,244.16
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cigna of CA HMO |
$1,792.00
|
| Rate for Payer: Cigna of CA PPO |
$1,792.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,176.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,176.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,024.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,024.00
|
| Rate for Payer: Galaxy Health WC |
$2,176.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,536.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,091.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,707.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,234.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,584.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,792.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,792.00
|
| Rate for Payer: Multiplan Commercial |
$2,048.00
|
| Rate for Payer: Networks By Design Commercial |
$1,280.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,176.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,536.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,536.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.77
|
| Rate for Payer: United Healthcare All Other HMO |
$935.17
|
| Rate for Payer: United Healthcare HMO Rider |
$914.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$838.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,176.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,176.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,176.00
|
|
|
HC BFLEX 2.8 BRONCHOSCOPE
|
Facility
|
IP
|
$808.00
|
|
| Hospital Charge Code |
900831711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$686.80 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.92
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
|
|
HC BFLEX 2.8 BRONCHOSCOPE
|
Facility
|
OP
|
$808.00
|
|
| Hospital Charge Code |
900831711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$686.80 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$529.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$444.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$606.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.19
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna of CA HMO |
$517.12
|
| Rate for Payer: Cigna of CA PPO |
$597.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$686.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$686.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$686.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$404.00
|
| Rate for Payer: United Healthcare All Other HMO |
$404.00
|
| Rate for Payer: United Healthcare HMO Rider |
$404.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$686.80
|
| Rate for Payer: Vantage Medical Group Senior |
$686.80
|
|
