|
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: Galaxy Health WC |
$8,585.00
|
| Rate for Payer: Adventist Health Commercial |
$2,020.00
|
| Rate for Payer: Cash Price |
$4,545.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,070.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,040.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,060.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,413.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,959.00
|
| 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
|
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 |
$1,343.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,706.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,125.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,409.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,309.21
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,409.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,309.21
|
| 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 |
$1,442.35
|
| 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
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
915356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,409.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,309.21
|
| 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 |
$1,442.35
|
| 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 |
$1,343.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,706.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,125.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,409.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,309.21
|
| 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 |
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 |
$1,343.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,706.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,125.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,409.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,309.21
|
| 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 |
915356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,409.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,309.21
|
| 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 |
$1,442.35
|
| 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 |
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 |
$1,343.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,706.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,125.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,409.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,309.21
|
| 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 |
$14,109.00 |
| Rate for Payer: Cash Price |
$998.55
|
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,409.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,309.21
|
| 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 |
$1,442.35
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,905.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,629.09
|
| 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 |
$3,998.15
|
| 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
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,905.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,629.09
|
| 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 |
$3,998.15
|
| 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 |
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 |
$3,723.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,730.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,118.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,689.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,905.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,629.09
|
| 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
|
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 |
$3,723.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,730.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,118.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,689.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,905.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,629.09
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,846.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,582.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,399.53
|
| 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
|
|
|
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 |
$575.78
|
| 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 |
$2,609.79
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,846.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,582.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,399.53
|
| 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: 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 |
905365501
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,846.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,582.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,399.53
|
| 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
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
OP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
915365501
|
|
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 |
$575.78
|
| 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 |
$2,609.79
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,846.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,582.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,399.53
|
| 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: 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 SHOES, DEPTH INLAY(PR)
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT L3230
|
| Hospital Charge Code |
905353230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$287.31 |
| Max. Negotiated Rate |
$1,798.60 |
| Rate for Payer: Adventist Health Commercial |
$867.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,798.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,163.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,280.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,627.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,072.81
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna of CA HMO |
$1,481.20
|
| Rate for Payer: Cigna of CA PPO |
$1,481.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,798.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,798.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,798.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,481.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$846.40
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,343.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,248.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,481.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,481.20
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: Networks By Design Commercial |
$1,058.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,269.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,269.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$794.13
|
| Rate for Payer: United Healthcare All Other HMO |
$772.97
|
| Rate for Payer: United Healthcare HMO Rider |
$756.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$692.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,798.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,798.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,798.60
|
|
|
HC CUSTOM SHOES, DEPTH INLAY(PR)
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
CPT L3230
|
| Hospital Charge Code |
905353230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna of CA HMO |
$1,481.20
|
| Rate for Payer: Cigna of CA PPO |
$1,481.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,481.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$846.40
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,343.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,248.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.84
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: Networks By Design Commercial |
$1,375.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$794.13
|
| Rate for Payer: United Healthcare All Other HMO |
$772.97
|
| Rate for Payer: United Healthcare HMO Rider |
$756.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$692.99
|
|
|
HC CUTTING BALLOON
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,344.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$768.00
|
| Rate for Payer: Galaxy Health WC |
$1,632.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,152.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,219.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,132.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.80
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: Networks By Design Commercial |
$1,248.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,632.00
|
|
|
HC CUTTING BALLOON
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$26,837.02 |
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,837.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,056.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,440.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,232.06
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna of CA HMO |
$1,228.80
|
| Rate for Payer: Cigna of CA PPO |
$1,420.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,632.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,632.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,344.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$768.00
|
| Rate for Payer: Galaxy Health WC |
$1,632.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,152.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,219.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$696.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,132.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,344.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: Networks By Design Commercial |
$1,248.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,632.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,152.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,152.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Other HMO |
$960.00
|
| Rate for Payer: United Healthcare HMO Rider |
$960.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$960.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,632.00
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.80 |
| Max. Negotiated Rate |
$866.15 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$713.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: EPIC Health Plan Senior |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$647.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.56
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.80 |
| Max. Negotiated Rate |
$2,906.51 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,906.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$560.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$653.89
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cigna of CA HMO |
$652.16
|
| Rate for Payer: Cigna of CA PPO |
$754.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$866.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$866.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$866.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$713.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: EPIC Health Plan Senior |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$647.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$369.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$713.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$713.30
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$611.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$611.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.50
|
| Rate for Payer: United Healthcare All Other HMO |
$509.50
|
| Rate for Payer: United Healthcare HMO Rider |
$509.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$866.15
|
| Rate for Payer: Vantage Medical Group Senior |
$866.15
|
|
|
HC CVS SAMPLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$910.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$74.68
|
| Rate for Payer: Blue Shield of California Commercial |
$112.91
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$103.68
|
| Rate for Payer: Cigna of CA PPO |
$119.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.62
|
| Rate for Payer: EPIC Health Plan Senior |
$1,303.08
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,942.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,658.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,492.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,587.39
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.00
|
| Rate for Payer: United Healthcare All Other HMO |
$81.00
|
| Rate for Payer: United Healthcare HMO Rider |
$81.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,184.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.62
|
|
|
HC CVS SAMPLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
