|
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: Vantage Medical Group Senior |
$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 |
$5,327.25
|
| Rate for Payer: Blue Shield of California Commercial |
$6,767.97
|
| Rate for Payer: Blue Shield of California Commercial |
$4,462.11
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,331.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,588.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,192.59
|
| 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
|
|
|
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 |
$5,327.25
|
| Rate for Payer: Blue Shield of California Commercial |
$6,767.97
|
| Rate for Payer: Blue Shield of California Commercial |
$4,462.11
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,331.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,588.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,192.59
|
| 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
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,760.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5,588.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,192.59
|
| 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 |
$5,720.65
|
| 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 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 |
$856.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,332.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,209.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,123.36
|
| 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 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 |
$2,278.41 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,523.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$895.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,278.41
|
| Rate for Payer: Blue Shield of California Commercial |
$801.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,214.75
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| 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 |
$1,343.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$985.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,478.04
|
| Rate for Payer: EPIC Health Plan Senior |
$985.36
|
| 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/Senior |
$1,469.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$895.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,209.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$552.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,128.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,200.35
|
| 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 |
$895.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Vantage Medical Group Senior |
$895.78
|
|
|
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 |
$4,149.26 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,774.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$895.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,149.26
|
| Rate for Payer: Blue Shield of California Commercial |
$801.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,214.75
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| 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 |
$1,343.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$985.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,478.04
|
| Rate for Payer: EPIC Health Plan Senior |
$985.36
|
| 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/Senior |
$1,469.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$908.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$895.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,209.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,027.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,128.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,200.35
|
| 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 |
$895.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Vantage Medical Group Senior |
$895.78
|
|
|
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: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,332.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,209.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,123.36
|
| 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
|
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 |
$856.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,332.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,209.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,123.36
|
| 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 |
$6,547.05 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,385.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$895.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,547.05
|
| Rate for Payer: Blue Shield of California Commercial |
$801.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,214.75
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| 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 |
$1,343.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$985.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,478.04
|
| Rate for Payer: EPIC Health Plan Senior |
$985.36
|
| 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/Senior |
$1,469.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,361.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$895.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,209.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,540.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,128.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,200.35
|
| 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 |
$895.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Vantage Medical Group Senior |
$895.78
|
|
|
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 |
$14,109.00
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$11,821.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,984.03
|
| 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 |
$12,101.05
|
| 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 |
$14,109.00
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$11,821.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,984.03
|
| 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 |
$12,101.05
|
| 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 |
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 |
$11,268.87
|
| Rate for Payer: Blue Shield of California Commercial |
$9,438.82
|
| Rate for Payer: Blue Shield of California Commercial |
$14,316.47
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,625.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,821.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,984.03
|
| 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
|
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 |
$11,268.87
|
| Rate for Payer: Blue Shield of California Commercial |
$9,438.82
|
| Rate for Payer: Blue Shield of California Commercial |
$14,316.47
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,625.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,821.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,984.03
|
| 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
|
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 |
$449.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,192.92
|
| Rate for Payer: Blue Shield of California Commercial |
$782.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,186.04
|
| Rate for Payer: Cash Price |
$836.55
|
| Rate for Payer: Cash Price |
$836.55
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,301.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| 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/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,180.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$836.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,301.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,180.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,096.81
|
| 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 SCARVES
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380013
|
|
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 |
$29.66
|
| Rate for Payer: Blue Shield of California Commercial |
$24.84
|
| Rate for Payer: Blue Shield of California Commercial |
$37.68
|
| Rate for Payer: Cash Price |
$22.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| 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 |
915380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| 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 |
$31.85
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| 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 |
$31.85
|
| 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
|
|
|
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 |
$29.66
|
| Rate for Payer: Blue Shield of California Commercial |
$24.84
|
| Rate for Payer: Blue Shield of California Commercial |
$37.68
|
| Rate for Payer: Cash Price |
$22.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| 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 HEART CATH CONGENITAL R & L
|
Facility
|
OP
|
$10,044.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,008.80 |
| Max. Negotiated Rate |
$16,261.00 |
| Rate for Payer: Adventist Health Commercial |
$2,008.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,537.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,524.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,533.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: Cigna of CA HMO |
$6,528.60
|
| Rate for Payer: Cigna of CA PPO |
$7,432.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,537.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,537.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,537.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,030.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,017.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,017.60
|
| Rate for Payer: Galaxy Health WC |
$8,537.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,026.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,377.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,645.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,410.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,030.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,030.80
|
| Rate for Payer: Multiplan Commercial |
$8,035.20
|
| Rate for Payer: Networks By Design Commercial |
$6,528.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,537.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,026.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,026.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,022.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,022.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,022.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,022.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,537.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,537.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,537.40
|
|
|
HC HEART CATH CONGENITAL R & L
|
Facility
|
IP
|
$10,044.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,008.80 |
| Max. Negotiated Rate |
$8,537.40 |
| Rate for Payer: Adventist Health Commercial |
$2,008.80
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,030.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,017.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,017.60
|
| Rate for Payer: Galaxy Health WC |
$8,537.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,026.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,377.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,410.56
|
| Rate for Payer: Multiplan Commercial |
$8,035.20
|
| Rate for Payer: Networks By Design Commercial |
$6,528.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,537.40
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
IP
|
$8,035.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,607.00 |
| Max. Negotiated Rate |
$6,829.75 |
| Rate for Payer: Adventist Health Commercial |
$1,607.00
|
| Rate for Payer: Cash Price |
$3,615.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,624.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,214.00
|
| Rate for Payer: Galaxy Health WC |
$6,829.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,821.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,102.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,740.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,928.40
|
| Rate for Payer: Multiplan Commercial |
$6,428.00
|
| Rate for Payer: Networks By Design Commercial |
$5,222.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,829.75
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
OP
|
$8,035.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,607.00 |
| Max. Negotiated Rate |
$9,759.00 |
| Rate for Payer: Adventist Health Commercial |
$1,607.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,829.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,419.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,026.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$3,615.75
|
| Rate for Payer: Cash Price |
$3,615.75
|
| Rate for Payer: Cigna of CA HMO |
$5,222.75
|
| Rate for Payer: Cigna of CA PPO |
$5,945.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,829.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,829.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,829.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,624.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,214.00
|
| Rate for Payer: Galaxy Health WC |
$6,829.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,821.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,102.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,916.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,740.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,928.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,624.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,624.50
|
| Rate for Payer: Multiplan Commercial |
$6,428.00
|
| Rate for Payer: Networks By Design Commercial |
$5,222.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,829.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,821.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,821.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,017.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,017.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,017.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,017.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,829.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,829.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,829.75
|
|
|
HC HEAVY DUTY ELBOW FEATURE
|
Facility
|
OP
|
$2,573.00
|
|
|
Service Code
|
CPT L6639
|
| Hospital Charge Code |
905356639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$617.52 |
| Max. Negotiated Rate |
$2,187.05 |
| Rate for Payer: Adventist Health Commercial |
$1,054.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,415.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,929.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,557.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,304.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,978.64
|
| Rate for Payer: Cash Price |
$1,157.85
|
| Rate for Payer: Cigna of CA HMO |
$1,801.10
|
| Rate for Payer: Cigna of CA PPO |
$1,801.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,187.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,187.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,801.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.20
|
| Rate for Payer: Galaxy Health WC |
$2,187.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,543.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,633.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$934.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,518.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,801.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,801.10
|
| Rate for Payer: Multiplan Commercial |
$2,058.40
|
| Rate for Payer: Networks By Design Commercial |
$1,286.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,543.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,543.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.65
|
| Rate for Payer: United Healthcare All Other HMO |
$939.92
|
| Rate for Payer: United Healthcare HMO Rider |
$919.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,187.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,187.05
|
|
|
HC HEAVY DUTY ELBOW FEATURE
|
Facility
|
IP
|
$2,573.00
|
|
|
Service Code
|
CPT L6639
|
| Hospital Charge Code |
905356639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$514.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$514.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,157.85
|
| Rate for Payer: Cash Price |
$1,157.85
|
| Rate for Payer: Cigna of CA HMO |
$1,801.10
|
| Rate for Payer: Cigna of CA PPO |
$1,801.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,801.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.20
|
| Rate for Payer: Galaxy Health WC |
$2,187.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,543.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,633.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,518.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.52
|
| Rate for Payer: Multiplan Commercial |
$2,058.40
|
| Rate for Payer: Networks By Design Commercial |
$1,672.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.65
|
| Rate for Payer: United Healthcare All Other HMO |
$939.92
|
| Rate for Payer: United Healthcare HMO Rider |
$919.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.66
|
|
