|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,241.84 |
| Max. Negotiated Rate |
$7,939.85 |
| Rate for Payer: Adventist Health Commercial |
$3,829.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,137.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,410.31
|
| Rate for Payer: Blue Shield of California Commercial |
$6,893.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,539.73
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,939.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,939.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,277.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,241.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,538.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,538.70
|
| Rate for Payer: Multiplan Commercial |
$7,472.80
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,604.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,604.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,939.85
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,241.84 |
| Max. Negotiated Rate |
$7,939.85 |
| Rate for Payer: Adventist Health Commercial |
$3,829.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,137.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,410.31
|
| Rate for Payer: Blue Shield of California Commercial |
$6,893.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,539.73
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,939.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,939.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,277.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,241.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,538.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,538.70
|
| Rate for Payer: Multiplan Commercial |
$7,472.80
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,604.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,604.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,939.85
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,868.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,558.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,241.84
|
| Rate for Payer: Multiplan Commercial |
$7,472.80
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
915355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.92 |
| Max. Negotiated Rate |
$1,536.80 |
| Rate for Payer: Adventist Health Commercial |
$741.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,047.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,334.30
|
| Rate for Payer: Blue Shield of California EPN |
$878.69
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,536.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,054.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.60
|
| Rate for Payer: Multiplan Commercial |
$1,446.40
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
915355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$361.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.40
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.92 |
| Max. Negotiated Rate |
$1,536.80 |
| Rate for Payer: Adventist Health Commercial |
$741.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,047.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,334.30
|
| Rate for Payer: Blue Shield of California EPN |
$878.69
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,536.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,054.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.60
|
| Rate for Payer: Multiplan Commercial |
$1,446.40
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Adventist Health Commercial |
$361.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
915355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,760.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,760.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,353.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.24
|
| Rate for Payer: Multiplan Commercial |
$7,040.80
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,760.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,760.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,353.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.24
|
| Rate for Payer: Multiplan Commercial |
$7,040.80
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
915355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,112.24 |
| Max. Negotiated Rate |
$7,480.85 |
| Rate for Payer: Adventist Health Commercial |
$3,608.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,097.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6,495.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,277.29
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,480.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,480.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,331.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,160.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,160.70
|
| Rate for Payer: Multiplan Commercial |
$7,040.80
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,112.24 |
| Max. Negotiated Rate |
$7,480.85 |
| Rate for Payer: Adventist Health Commercial |
$3,608.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,097.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6,495.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,277.29
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,480.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,480.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,331.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,160.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,160.70
|
| Rate for Payer: Multiplan Commercial |
$7,040.80
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 1 CHNL
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
909100450
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$2,180.30 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,248.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,180.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.25
|
| Rate for Payer: Blue Shield of California EPN |
$769.22
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cigna of CA HMO |
$1,218.56
|
| Rate for Payer: Cigna of CA PPO |
$1,408.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,110.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 1 CHNL
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
909100450
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$1,618.40 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Senior |
$761.60
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,178.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 2-12 CHNLS
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
909100451
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$1,618.40 |
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Senior |
$761.60
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,178.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 2-12 CHNLS
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
909100451
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$3,970.60 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,248.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,970.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.25
|
| Rate for Payer: Blue Shield of California EPN |
$769.22
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cigna of CA HMO |
$1,218.56
|
| Rate for Payer: Cigna of CA PPO |
$1,408.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$908.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,027.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,110.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY OVER 12 CHNLS
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
909100452
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$1,618.40 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Senior |
$761.60
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,178.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY OVER 12 CHNLS
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
909100452
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$6,265.15 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,248.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,265.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.25
|
| Rate for Payer: Blue Shield of California EPN |
$769.22
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cigna of CA HMO |
$1,218.56
|
| Rate for Payer: Cigna of CA PPO |
$1,408.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,361.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,110.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
OP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,468.08 |
| Max. Negotiated Rate |
$15,824.45 |
| Rate for Payer: Adventist Health Commercial |
$7,632.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,239.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,962.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,782.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13,739.35
|
| Rate for Payer: Blue Shield of California EPN |
$9,047.86
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,824.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,824.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,625.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,468.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,031.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,031.90
|
| Rate for Payer: Multiplan Commercial |
$14,893.60
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,170.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,170.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,824.45
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
IP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,723.40 |
| Max. Negotiated Rate |
$15,824.45 |
| Rate for Payer: Adventist Health Commercial |
$3,723.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,093.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,468.08
|
| Rate for Payer: Multiplan Commercial |
$14,893.60
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
IP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
915355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,723.40 |
| Max. Negotiated Rate |
$15,824.45 |
| Rate for Payer: Adventist Health Commercial |
$3,723.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,093.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,468.08
|
| Rate for Payer: Multiplan Commercial |
$14,893.60
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
OP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
915355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,468.08 |
| Max. Negotiated Rate |
$15,824.45 |
| Rate for Payer: Adventist Health Commercial |
$7,632.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,239.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,962.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,782.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13,739.35
|
| Rate for Payer: Blue Shield of California EPN |
$9,047.86
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,824.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,824.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,625.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,468.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,031.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,031.90
|
| Rate for Payer: Multiplan Commercial |
$14,893.60
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,170.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,170.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,824.45
|
|
|
HC HEAD ECHO
|
Facility
|
IP
|
$1,859.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$1,580.15 |
| Rate for Payer: Adventist Health Commercial |
$371.80
|
| Rate for Payer: Cash Price |
$1,022.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.60
|
| Rate for Payer: EPIC Health Plan Senior |
$743.60
|
| Rate for Payer: Galaxy Health WC |
$1,580.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,115.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,150.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.16
|
| Rate for Payer: Multiplan Commercial |
$1,487.20
|
| Rate for Payer: Networks By Design Commercial |
$1,208.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,580.15
|
|
|
HC HEAD ECHO
|
Facility
|
OP
|
$1,859.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$1,580.15 |
| Rate for Payer: Adventist Health Commercial |
$371.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,219.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,141.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,137.71
|
| Rate for Payer: Blue Shield of California EPN |
$751.04
|
| Rate for Payer: Cash Price |
$1,022.45
|
| Rate for Payer: Cash Price |
$1,022.45
|
| Rate for Payer: Cigna of CA HMO |
$1,189.76
|
| Rate for Payer: Cigna of CA PPO |
$1,375.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,580.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,115.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,487.20
|
| Rate for Payer: Networks By Design Commercial |
$1,208.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,580.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,115.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,115.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC HEAD SCARVES
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$41.65 |
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.38
|
| Rate for Payer: Blue Shield of California Commercial |
$36.16
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC HEAD SCARVES
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
|
