|
HC CULTURE UROGENITAL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$156.00
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$241.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
|
|
HC CULTURE WOUND
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911520
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$156.00
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$241.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
|
|
HC CULTURE WOUND
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911520
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.98
|
| Rate for Payer: Blue Shield of California Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.13
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.64
|
| Rate for Payer: EPIC Health Plan Senior |
$8.62
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.55
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Vantage Medical Group Senior |
$8.62
|
|
|
HC CULTURE YEAST ID
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
900911555
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$101.94 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.94
|
| Rate for Payer: Blue Shield of California Commercial |
$58.87
|
| Rate for Payer: Blue Shield of California EPN |
$38.90
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.93
|
| Rate for Payer: EPIC Health Plan Senior |
$10.32
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.83
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.36
|
| Rate for Payer: United Healthcare All Other HMO |
$8.36
|
| Rate for Payer: United Healthcare HMO Rider |
$8.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.32
|
|
|
HC CULTURE YEAST ID
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
900911555
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC CULTURE YEAST RAPID ID
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912425
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$48.17
|
| Rate for Payer: Blue Shield of California EPN |
$31.82
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE YEAST RAPID ID
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912425
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC CULTURE YERSINIA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC CULTURE YERSINIA
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.27
|
| Rate for Payer: Blue Shield of California Commercial |
$23.41
|
| Rate for Payer: Blue Shield of California EPN |
$15.47
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.74
|
| Rate for Payer: EPIC Health Plan Senior |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.65
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.65
|
| Rate for Payer: United Healthcare HMO Rider |
$7.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC CURETTAGE, POSTPARTUM
|
Facility
|
OP
|
$10,100.00
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
988169160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.50 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,020.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$4,545.00
|
| Rate for Payer: Cash Price |
$4,545.00
|
| Rate for Payer: Cash Price |
$4,545.00
|
| Rate for Payer: Cigna of CA HMO |
$6,464.00
|
| Rate for Payer: Cigna of CA PPO |
$7,474.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$8,585.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,060.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$340.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,736.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,424.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$8,080.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$6,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,585.00
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,060.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC CURETTAGE, POSTPARTUM
|
Facility
|
IP
|
$10,100.00
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
988169160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,020.00 |
| Max. Negotiated Rate |
$8,585.00 |
| Rate for Payer: Adventist Health Commercial |
$2,020.00
|
| Rate for Payer: Cash Price |
$4,545.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,040.00
|
| Rate for Payer: Galaxy Health WC |
$8,585.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,060.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,736.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,848.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,251.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,424.00
|
| Rate for Payer: Multiplan Commercial |
$8,080.00
|
| Rate for Payer: Networks By Design Commercial |
$6,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,585.00
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
915356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.56
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
915356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.56 |
| Max. Negotiated Rate |
$1,886.15 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,285.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,637.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,078.43
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
905356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.56
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
905356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.56 |
| Max. Negotiated Rate |
$1,886.15 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,285.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,637.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,078.43
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
905356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.56
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
915356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.56
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
915356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.56 |
| Max. Negotiated Rate |
$1,886.15 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,285.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,637.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,078.43
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
905356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.56 |
| Max. Negotiated Rate |
$1,886.15 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,285.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,637.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,078.43
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
OP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
905358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,476.24 |
| Max. Negotiated Rate |
$5,228.35 |
| Rate for Payer: Adventist Health Commercial |
$2,521.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,383.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,613.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,562.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4,539.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,989.39
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,228.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,228.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,689.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,305.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,305.70
|
| Rate for Payer: Multiplan Commercial |
$4,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,690.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,228.35
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
IP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
905358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,230.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,343.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.24
|
| Rate for Payer: Multiplan Commercial |
$4,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
OP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
915358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,476.24 |
| Max. Negotiated Rate |
$5,228.35 |
| Rate for Payer: Adventist Health Commercial |
$2,521.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,383.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,613.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,562.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4,539.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,989.39
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,228.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,228.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,689.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,305.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,305.70
|
| Rate for Payer: Multiplan Commercial |
$4,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,690.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,228.35
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
IP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
915358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,230.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cash Price |
$2,767.95
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,343.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.24
|
| Rate for Payer: Multiplan Commercial |
$4,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
OP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
905365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$239.28 |
| Max. Negotiated Rate |
$3,456.95 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,667.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,050.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,497.54
|
| Rate for Payer: Cash Price |
$1,830.15
|
| Rate for Payer: Cash Price |
$1,830.15
|
| Rate for Payer: Cigna of CA HMO |
$2,602.88
|
| Rate for Payer: Cigna of CA PPO |
$3,009.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,456.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,456.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$976.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,846.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.90
|
| Rate for Payer: Multiplan Commercial |
$3,253.60
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,440.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,440.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,033.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,033.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,033.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,033.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
IP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
915365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$813.40 |
| Max. Negotiated Rate |
$3,456.95 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Cash Price |
$1,830.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$976.08
|
| Rate for Payer: Multiplan Commercial |
$3,253.60
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
|
