|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
IP
|
$4,688.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$937.60 |
| Max. Negotiated Rate |
$3,984.80 |
| Rate for Payer: Adventist Health Commercial |
$937.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,875.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,875.20
|
| Rate for Payer: Galaxy Health WC |
$3,984.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,126.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,786.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,901.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.12
|
| Rate for Payer: Multiplan Commercial |
$3,750.40
|
| Rate for Payer: Networks By Design Commercial |
$3,047.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,984.80
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
OP
|
$4,688.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$5,714.55 |
| Rate for Payer: Adventist Health Commercial |
$937.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cigna of CA HMO |
$3,000.32
|
| Rate for Payer: Cigna of CA PPO |
$3,469.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,704.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.48
|
| Rate for Payer: Galaxy Health WC |
$3,984.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,714.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,126.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,669.20
|
| Rate for Payer: Multiplan Commercial |
$3,750.40
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$3,047.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,984.80
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,812.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,344.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,344.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,344.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,484.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC PROGESTERONE
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$206.07 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.07
|
| Rate for Payer: Blue Shield of California Commercial |
$70.91
|
| Rate for Payer: Blue Shield of California EPN |
$46.85
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.16
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.89
|
| Rate for Payer: United Healthcare All Other HMO |
$16.89
|
| Rate for Payer: United Healthcare HMO Rider |
$16.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC PROGESTERONE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$191.38 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.38
|
| Rate for Payer: Blue Shield of California Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.13
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.16
|
| Rate for Payer: EPIC Health Plan Senior |
$19.38
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.97
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Other HMO |
$15.70
|
| Rate for Payer: United Healthcare HMO Rider |
$15.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Vantage Medical Group Senior |
$19.38
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$176.00
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$672.35 |
| Rate for Payer: Adventist Health Commercial |
$158.20
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.40
|
| Rate for Payer: EPIC Health Plan Senior |
$316.40
|
| Rate for Payer: Galaxy Health WC |
$672.35
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$489.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.84
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$158.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cigna of CA HMO |
$506.24
|
| Rate for Payer: Cigna of CA PPO |
$585.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$672.35
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$395.50
|
| Rate for Payer: United Healthcare All Other HMO |
$395.50
|
| Rate for Payer: United Healthcare HMO Rider |
$395.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$395.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC PROPORT CNTR 12 VOLT UTAH
|
Facility
|
IP
|
$18,471.00
|
|
|
Service Code
|
CPT L7274
|
| Hospital Charge Code |
905357274
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,694.20 |
| Max. Negotiated Rate |
$15,700.35 |
| Rate for Payer: Adventist Health Commercial |
$3,694.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,311.95
|
| Rate for Payer: Cash Price |
$8,311.95
|
| Rate for Payer: Cigna of CA HMO |
$12,929.70
|
| Rate for Payer: Cigna of CA PPO |
$12,929.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,388.40
|
| Rate for Payer: Galaxy Health WC |
$15,700.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,082.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,037.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,433.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,433.04
|
| Rate for Payer: Multiplan Commercial |
$14,776.80
|
| Rate for Payer: Networks By Design Commercial |
$9,235.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,700.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,932.17
|
| Rate for Payer: United Healthcare All Other HMO |
$6,747.46
|
| Rate for Payer: United Healthcare HMO Rider |
$6,601.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,049.25
|
|
|
HC PROPORT CNTR 12 VOLT UTAH
|
Facility
|
OP
|
$18,471.00
|
|
|
Service Code
|
CPT L7274
|
| Hospital Charge Code |
905357274
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,433.04 |
| Max. Negotiated Rate |
$15,700.35 |
| Rate for Payer: Adventist Health Commercial |
$7,573.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,700.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,159.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,853.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,631.60
|
| Rate for Payer: Blue Shield of California EPN |
$8,976.91
|
| Rate for Payer: Cash Price |
$8,311.95
|
| Rate for Payer: Cigna of CA HMO |
$12,929.70
|
| Rate for Payer: Cigna of CA PPO |
$12,929.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,700.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,700.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,700.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,388.40
|
| Rate for Payer: Galaxy Health WC |
$15,700.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,082.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,037.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,433.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,433.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,929.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,929.70
|
| Rate for Payer: Multiplan Commercial |
$14,776.80
|
| Rate for Payer: Networks By Design Commercial |
$9,235.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,700.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,082.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,082.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,932.17
|
| Rate for Payer: United Healthcare All Other HMO |
$6,747.46
|
| Rate for Payer: United Healthcare HMO Rider |
$6,601.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,049.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,700.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,700.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15,700.35
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
905355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
915355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$488.16 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$833.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,118.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,525.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,178.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,501.09
|
| Rate for Payer: Blue Shield of California EPN |
$988.52
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,728.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,423.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,423.80
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,728.90
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
915355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
905355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$488.16 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$833.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,118.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,525.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,178.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,501.09
|
| Rate for Payer: Blue Shield of California EPN |
$988.52
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,728.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,423.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,423.80
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.36
|
| Rate for Payer: United Healthcare All Other HMO |
$743.02
|
| Rate for Payer: United Healthcare HMO Rider |
$726.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$666.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,728.90
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
915355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: Adventist Health Commercial |
$554.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,014.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$783.66
|
| Rate for Payer: Blue Shield of California Commercial |
$998.51
|
| Rate for Payer: Blue Shield of California EPN |
$657.56
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,150.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,150.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$837.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$947.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$947.10
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,150.05
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
905355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$270.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$837.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
915355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$270.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$837.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
905355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: Adventist Health Commercial |
$554.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,014.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$783.66
|
| Rate for Payer: Blue Shield of California Commercial |
$998.51
|
| Rate for Payer: Blue Shield of California EPN |
$657.56
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,150.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,150.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$837.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$947.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$947.10
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$507.78
|
| Rate for Payer: United Healthcare All Other HMO |
$494.25
|
| Rate for Payer: United Healthcare HMO Rider |
$483.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,150.05
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
905355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.84 |
| Max. Negotiated Rate |
$1,968.60 |
| Rate for Payer: Adventist Health Commercial |
$949.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,273.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,737.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,341.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,709.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,125.58
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,968.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,968.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$631.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$714.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,621.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,621.20
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,389.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,389.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,968.60
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
915355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$463.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
905355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$463.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
915355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.84 |
| Max. Negotiated Rate |
$1,968.60 |
| Rate for Payer: Adventist Health Commercial |
$949.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,273.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,737.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,341.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,709.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,125.58
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,968.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,968.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$631.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$714.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,621.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,621.20
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,389.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,389.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,968.60
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,496.88 |
| Rate for Payer: Adventist Health Commercial |
$1,204.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,701.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,167.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,496.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,496.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,056.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,056.25
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Senior |
$2,496.88
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$587.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB IP
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$587.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
|
