|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
OP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
915356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,198.64 |
| Max. Negotiated Rate |
$7,786.85 |
| Rate for Payer: Adventist Health Commercial |
$3,756.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,038.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,870.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,306.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6,760.82
|
| Rate for Payer: Blue Shield of California EPN |
$4,452.25
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,786.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,786.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,605.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,339.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,670.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,198.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,412.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,412.70
|
| Rate for Payer: Multiplan Commercial |
$7,328.80
|
| Rate for Payer: Networks By Design Commercial |
$4,580.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,496.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,496.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,786.85
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
OP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
905356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,200.56 |
| Max. Negotiated Rate |
$39,668.65 |
| Rate for Payer: Adventist Health Commercial |
$19,134.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,667.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,030.68
|
| Rate for Payer: Blue Shield of California Commercial |
$34,441.72
|
| Rate for Payer: Blue Shield of California EPN |
$22,681.13
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,668.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,668.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,524.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,295.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,200.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,668.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,668.30
|
| Rate for Payer: Multiplan Commercial |
$37,335.20
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,001.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Senior |
$39,668.65
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
IP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
915356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,333.80 |
| Max. Negotiated Rate |
$39,668.65 |
| Rate for Payer: Adventist Health Commercial |
$9,333.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,780.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,200.56
|
| Rate for Payer: Multiplan Commercial |
$37,335.20
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
OP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
915356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,200.56 |
| Max. Negotiated Rate |
$39,668.65 |
| Rate for Payer: Adventist Health Commercial |
$19,134.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,667.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,030.68
|
| Rate for Payer: Blue Shield of California Commercial |
$34,441.72
|
| Rate for Payer: Blue Shield of California EPN |
$22,681.13
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,668.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,668.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,524.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,295.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,200.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,668.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,668.30
|
| Rate for Payer: Multiplan Commercial |
$37,335.20
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,001.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Senior |
$39,668.65
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
IP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
905356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,333.80 |
| Max. Negotiated Rate |
$39,668.65 |
| Rate for Payer: Adventist Health Commercial |
$9,333.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,780.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,200.56
|
| Rate for Payer: Multiplan Commercial |
$37,335.20
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
IP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
905356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,502.80 |
| Max. Negotiated Rate |
$31,886.90 |
| Rate for Payer: Adventist Health Commercial |
$7,502.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,292.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,221.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,003.36
|
| Rate for Payer: Multiplan Commercial |
$30,011.20
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
OP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
905356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,003.36 |
| Max. Negotiated Rate |
$31,886.90 |
| Rate for Payer: Adventist Health Commercial |
$15,380.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,632.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,135.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,728.11
|
| Rate for Payer: Blue Shield of California Commercial |
$27,685.33
|
| Rate for Payer: Blue Shield of California EPN |
$18,231.80
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,886.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,886.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,877.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,433.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,221.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,003.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,259.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,259.80
|
| Rate for Payer: Multiplan Commercial |
$30,011.20
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,508.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Senior |
$31,886.90
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
OP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
915356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,003.36 |
| Max. Negotiated Rate |
$31,886.90 |
| Rate for Payer: Adventist Health Commercial |
$15,380.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,632.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,135.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,728.11
|
| Rate for Payer: Blue Shield of California Commercial |
$27,685.33
|
| Rate for Payer: Blue Shield of California EPN |
$18,231.80
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,886.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,886.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,877.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,433.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,221.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,003.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,259.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,259.80
|
| Rate for Payer: Multiplan Commercial |
$30,011.20
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,508.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Senior |
$31,886.90
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
IP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
915356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,502.80 |
| Max. Negotiated Rate |
$31,886.90 |
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Adventist Health Commercial |
$7,502.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,292.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,221.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,003.36
|
| Rate for Payer: Multiplan Commercial |
$30,011.20
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
IP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
915356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,981.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,981.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,608.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,774.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,133.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,377.92
|
| Rate for Payer: Multiplan Commercial |
$7,926.40
|
| Rate for Payer: Networks By Design Commercial |
$4,954.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,718.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,541.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,244.87
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
OP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
905356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,377.92 |
| Max. Negotiated Rate |
$8,421.80 |
| Rate for Payer: Adventist Health Commercial |
$4,062.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,449.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,431.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,738.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7,312.10
|
| Rate for Payer: Blue Shield of California EPN |
$4,815.29
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,421.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,421.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,268.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,608.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,827.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,133.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,377.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,935.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,935.60
|
| Rate for Payer: Multiplan Commercial |
$7,926.40
|
| Rate for Payer: Networks By Design Commercial |
$4,954.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,944.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,944.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,718.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,541.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,244.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,421.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,421.80
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
IP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
905356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,981.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,981.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,608.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,774.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,133.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,377.92
|
| Rate for Payer: Multiplan Commercial |
$7,926.40
|
| Rate for Payer: Networks By Design Commercial |
$4,954.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,718.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,541.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,244.87
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
OP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
915356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,377.92 |
| Max. Negotiated Rate |
$8,421.80 |
| Rate for Payer: Adventist Health Commercial |
$4,062.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,449.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,431.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,738.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7,312.10
|
| Rate for Payer: Blue Shield of California EPN |
$4,815.29
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,421.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,421.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,268.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,608.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,827.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,133.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,377.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,935.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,935.60
|
| Rate for Payer: Multiplan Commercial |
$7,926.40
|
| Rate for Payer: Networks By Design Commercial |
$4,954.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,944.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,944.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,718.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,541.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,244.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,421.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,421.80
|
|
|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
915356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$734.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,449.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,399.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,272.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.28
|
| Rate for Payer: Multiplan Commercial |
$2,937.60
|
| Rate for Payer: Networks By Design Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,378.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,312.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.58
|
|
|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
905356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$881.28 |
| Max. Negotiated Rate |
$3,121.20 |
| Rate for Payer: Adventist Health Commercial |
$1,505.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,019.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,754.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,126.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,709.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,784.59
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,121.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,121.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,238.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,449.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,531.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,272.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,570.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,570.40
|
| Rate for Payer: Multiplan Commercial |
$2,937.60
|
| Rate for Payer: Networks By Design Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,203.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,203.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,378.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,312.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,121.20
|
|
|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
915356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$881.28 |
| Max. Negotiated Rate |
$3,121.20 |
| Rate for Payer: Adventist Health Commercial |
$1,505.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,019.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,754.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,126.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,709.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,784.59
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,121.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,121.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,238.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,449.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,531.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,272.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,570.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,570.40
|
| Rate for Payer: Multiplan Commercial |
$2,937.60
|
| Rate for Payer: Networks By Design Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,203.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,203.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,378.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,312.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,121.20
|
|
|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
905356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$734.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,449.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,399.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,272.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.28
|
| Rate for Payer: Multiplan Commercial |
$2,937.60
|
| Rate for Payer: Networks By Design Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,378.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,312.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.58
|
|
|
HC IUD INSERTION
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$231.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$981.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$635.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$866.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$709.29
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cigna of CA HMO |
$739.20
|
| Rate for Payer: Cigna of CA PPO |
$854.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$981.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$981.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$981.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.00
|
| Rate for Payer: EPIC Health Plan Senior |
$462.00
|
| Rate for Payer: Galaxy Health WC |
$981.75
|
| Rate for Payer: Global Benefits Group Commercial |
$693.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$770.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$714.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$808.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$808.50
|
| Rate for Payer: Multiplan Commercial |
$924.00
|
| Rate for Payer: Networks By Design Commercial |
$750.75
|
| Rate for Payer: Prime Health Services Commercial |
$981.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$693.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$693.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$577.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$981.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$981.75
|
| Rate for Payer: Vantage Medical Group Senior |
$981.75
|
|
|
HC IUD INSERTION
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$981.75 |
| Rate for Payer: Adventist Health Commercial |
$231.00
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.00
|
| Rate for Payer: EPIC Health Plan Senior |
$462.00
|
| Rate for Payer: Galaxy Health WC |
$981.75
|
| Rate for Payer: Global Benefits Group Commercial |
$693.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$770.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$714.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.20
|
| Rate for Payer: Multiplan Commercial |
$924.00
|
| Rate for Payer: Networks By Design Commercial |
$750.75
|
| Rate for Payer: Prime Health Services Commercial |
$981.75
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO |
$629.12
|
| Rate for Payer: Cigna of CA PPO |
$727.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$655.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$589.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.50
|
| Rate for Payer: United Healthcare All Other HMO |
$491.50
|
| Rate for Payer: United Healthcare HMO Rider |
$491.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.72 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO |
$629.12
|
| Rate for Payer: Cigna of CA PPO |
$727.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$655.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$589.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$589.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.50
|
| Rate for Payer: United Healthcare All Other HMO |
$491.50
|
| Rate for Payer: United Healthcare HMO Rider |
$491.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$835.55 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.20
|
| Rate for Payer: EPIC Health Plan Senior |
$393.20
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$655.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$835.55 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.20
|
| Rate for Payer: EPIC Health Plan Senior |
$393.20
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$655.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$13,432.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.75 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,686.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$6,044.40
|
| Rate for Payer: Cash Price |
$6,044.40
|
| Rate for Payer: Cash Price |
$6,044.40
|
| Rate for Payer: Cigna of CA HMO |
$8,596.48
|
| Rate for Payer: Cigna of CA PPO |
$9,939.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,417.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,059.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$509.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,959.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,223.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,745.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,730.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,417.20
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,059.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
IP
|
$13,432.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,686.40 |
| Max. Negotiated Rate |
$11,417.20 |
| Rate for Payer: Adventist Health Commercial |
$2,686.40
|
| Rate for Payer: Cash Price |
$6,044.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,372.80
|
| Rate for Payer: Galaxy Health WC |
$11,417.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,059.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,959.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,117.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,314.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,223.68
|
| Rate for Payer: Multiplan Commercial |
$10,745.60
|
| Rate for Payer: Networks By Design Commercial |
$8,730.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,417.20
|
|
