|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
OP
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
905356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$800.12 |
| Max. Negotiated Rate |
$10,091.92 |
| Rate for Payer: Adventist Health Commercial |
$4,867.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,091.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,530.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,904.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,876.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,762.16
|
| Rate for Payer: Blue Shield of California EPN |
$5,770.21
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Cigna of CA HMO |
$8,311.00
|
| Rate for Payer: Cigna of CA PPO |
$8,311.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,091.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,091.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,091.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,749.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,749.14
|
| Rate for Payer: Galaxy Health WC |
$10,091.92
|
| Rate for Payer: Global Benefits Group Commercial |
$7,123.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$800.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,919.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,349.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,849.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,311.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,311.00
|
| Rate for Payer: Multiplan Commercial |
$9,498.28
|
| Rate for Payer: Networks By Design Commercial |
$5,936.43
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,123.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,123.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,455.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4,337.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4,243.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,888.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,091.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,091.92
|
| Rate for Payer: Vantage Medical Group Senior |
$10,091.92
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
IP
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
915356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,374.57 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,374.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Cigna of CA HMO |
$8,311.00
|
| Rate for Payer: Cigna of CA PPO |
$8,311.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,749.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,749.14
|
| Rate for Payer: Galaxy Health WC |
$10,091.92
|
| Rate for Payer: Global Benefits Group Commercial |
$7,123.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,919.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,523.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,349.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,849.48
|
| Rate for Payer: Multiplan Commercial |
$9,498.28
|
| Rate for Payer: Networks By Design Commercial |
$5,936.43
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,455.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4,337.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4,243.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,888.36
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
IP
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
905356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,374.57 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,374.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Cigna of CA HMO |
$8,311.00
|
| Rate for Payer: Cigna of CA PPO |
$8,311.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,749.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,749.14
|
| Rate for Payer: Galaxy Health WC |
$10,091.92
|
| Rate for Payer: Global Benefits Group Commercial |
$7,123.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,919.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,523.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,349.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,849.48
|
| Rate for Payer: Multiplan Commercial |
$9,498.28
|
| Rate for Payer: Networks By Design Commercial |
$5,936.43
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,455.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4,337.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4,243.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,888.36
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.07
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.00
|
| Rate for Payer: United Healthcare All Other HMO |
$123.00
|
| Rate for Payer: United Healthcare HMO Rider |
$123.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$227.40 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$625.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$703.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$745.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$698.23
|
| Rate for Payer: Blue Shield of California Commercial |
$695.84
|
| Rate for Payer: Blue Shield of California EPN |
$459.35
|
| Rate for Payer: Cash Price |
$625.35
|
| Rate for Payer: Cash Price |
$625.35
|
| Rate for Payer: Cigna of CA HMO |
$727.68
|
| Rate for Payer: Cigna of CA PPO |
$841.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$682.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
915352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$278.76 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$540.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$989.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$763.96
|
| Rate for Payer: Blue Shield of California Commercial |
$973.42
|
| Rate for Payer: Blue Shield of California EPN |
$641.03
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,121.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,121.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.30
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,121.15
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
915352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$278.76 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$540.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$989.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$763.96
|
| Rate for Payer: Blue Shield of California Commercial |
$973.42
|
| Rate for Payer: Blue Shield of California EPN |
$641.03
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,121.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,121.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.30
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,121.15
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
915352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
915352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.04 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$326.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$461.04
|
| Rate for Payer: Blue Shield of California Commercial |
$587.45
|
| Rate for Payer: Blue Shield of California EPN |
$386.86
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$676.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$557.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.04 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$326.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$461.04
|
| Rate for Payer: Blue Shield of California Commercial |
$587.45
|
| Rate for Payer: Blue Shield of California EPN |
$386.86
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$676.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$557.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$7,672.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,534.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$4,219.60
|
| Rate for Payer: Cash Price |
$4,219.60
|
| Rate for Payer: Cash Price |
$4,219.60
|
| Rate for Payer: Cigna of CA HMO |
$4,910.08
|
| Rate for Payer: Cigna of CA PPO |
$5,677.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,603.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,117.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$6,137.60
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,986.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,521.20
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,603.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,836.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,836.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,836.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
IP
|
$7,672.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,534.40 |
| Max. Negotiated Rate |
$6,521.20 |
| Rate for Payer: Adventist Health Commercial |
$1,534.40
|
| Rate for Payer: Cash Price |
$4,219.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,068.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,068.80
|
| Rate for Payer: Galaxy Health WC |
$6,521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,603.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,117.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,923.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,748.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.28
|
| Rate for Payer: Multiplan Commercial |
$6,137.60
|
| Rate for Payer: Networks By Design Commercial |
$4,986.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,521.20
|
|
|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$1,215.50 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$828.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.34
|
| Rate for Payer: Blue Shield of California EPN |
$694.98
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$518.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$1,215.50 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$828.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.34
|
| Rate for Payer: Blue Shield of California EPN |
$694.98
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$518.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIMMETRY
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.31
|
| Rate for Payer: Blue Shield of California Commercial |
$317.02
|
| Rate for Payer: Blue Shield of California EPN |
$209.27
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$440.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$440.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$362.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$362.60
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.30
|
| Rate for Payer: Vantage Medical Group Senior |
$440.30
|
|
|
HC PELVIMMETRY
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.40
|
| Rate for Payer: EPIC Health Plan Senior |
$258.40
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$399.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.04
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.32 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$423.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.49
|
| Rate for Payer: Blue Shield of California Commercial |
$395.35
|
| Rate for Payer: Blue Shield of California EPN |
$260.98
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cigna of CA HMO |
$413.44
|
| Rate for Payer: Cigna of CA PPO |
$478.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
