|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,623.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,262.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cigna of CA HMO |
$4,407.04
|
| Rate for Payer: Cigna of CA PPO |
$5,095.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,131.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,443.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,443.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,623.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,262.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
901200086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cigna of CA HMO |
$4,407.04
|
| Rate for Payer: Cigna of CA PPO |
$5,095.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,131.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
901200086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$5,853.10 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,623.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,262.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.64
|
| Rate for Payer: Multiplan Commercial |
$5,508.80
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
IP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
905356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,321.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,897.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,082.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
| Rate for Payer: Networks By Design Commercial |
$2,490.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
IP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
915356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,321.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,897.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,082.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
| Rate for Payer: Networks By Design Commercial |
$2,490.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
OP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
915356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,195.20 |
| Max. Negotiated Rate |
$4,233.00 |
| Rate for Payer: Adventist Health Commercial |
$2,041.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,739.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,884.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,675.24
|
| Rate for Payer: Blue Shield of California EPN |
$2,420.28
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,233.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,233.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,208.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,321.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,628.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,082.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,195.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,486.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,486.00
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
| Rate for Payer: Networks By Design Commercial |
$2,490.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,988.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,988.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,233.00
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
OP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
905356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,195.20 |
| Max. Negotiated Rate |
$4,233.00 |
| Rate for Payer: Adventist Health Commercial |
$2,041.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,739.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,884.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,675.24
|
| Rate for Payer: Blue Shield of California EPN |
$2,420.28
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,233.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,233.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,208.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,321.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,628.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,082.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,195.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,486.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,486.00
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
| Rate for Payer: Networks By Design Commercial |
$2,490.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,988.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,988.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,233.00
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
905356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,443.75 |
| Rate for Payer: Adventist Health Commercial |
$1,178.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,581.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,156.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,665.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,121.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,397.25
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,443.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,443.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,852.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,779.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,012.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,012.50
|
| Rate for Payer: Multiplan Commercial |
$2,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,725.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,725.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,443.75
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
915356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,443.75 |
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Adventist Health Commercial |
$1,178.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,581.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,156.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,665.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,121.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,397.25
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,443.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,443.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,852.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,779.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,012.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,012.50
|
| Rate for Payer: Multiplan Commercial |
$2,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,725.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,725.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,443.75
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
915356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$575.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,095.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,779.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.00
|
| Rate for Payer: Multiplan Commercial |
$2,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
905356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$575.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,095.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,779.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.00
|
| Rate for Payer: Multiplan Commercial |
$2,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
|
|
HC REPLC SOCKT SHLDR DIS/INTERC
|
Facility
|
IP
|
$7,105.00
|
|
|
Service Code
|
CPT L6885
|
| Hospital Charge Code |
915356885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,421.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Cigna of CA HMO |
$4,973.50
|
| Rate for Payer: Cigna of CA PPO |
$4,973.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,842.00
|
| Rate for Payer: Galaxy Health WC |
$6,039.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,263.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,739.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,707.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,397.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,705.20
|
| Rate for Payer: Multiplan Commercial |
$5,684.00
|
| Rate for Payer: Networks By Design Commercial |
$3,552.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,039.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,666.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2,595.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,326.89
|
|
|
HC REPLC SOCKT SHLDR DIS/INTERC
|
Facility
|
IP
|
$7,105.00
|
|
|
Service Code
|
CPT L6885
|
| Hospital Charge Code |
905356885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,421.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Cigna of CA HMO |
$4,973.50
|
| Rate for Payer: Cigna of CA PPO |
$4,973.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,842.00
|
| Rate for Payer: Galaxy Health WC |
$6,039.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,263.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,739.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,707.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,397.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,705.20
|
| Rate for Payer: Multiplan Commercial |
$5,684.00
|
| Rate for Payer: Networks By Design Commercial |
$3,552.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,039.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,666.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2,595.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,326.89
|
|
|
HC REPLC SOCKT SHLDR DIS/INTERC
|
Facility
|
OP
|
$7,105.00
|
|
|
Service Code
|
CPT L6885
|
| Hospital Charge Code |
915356885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$6,039.25 |
| Rate for Payer: Adventist Health Commercial |
$2,913.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,039.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,907.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,328.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,115.22
|
| Rate for Payer: Blue Shield of California Commercial |
$5,243.49
|
| Rate for Payer: Blue Shield of California EPN |
$3,453.03
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Cigna of CA HMO |
$4,973.50
|
| Rate for Payer: Cigna of CA PPO |
$4,973.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,039.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,039.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,039.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,842.00
|
| Rate for Payer: Galaxy Health WC |
$6,039.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,263.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,577.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,739.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,176.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,397.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,705.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,973.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,973.50
|
| Rate for Payer: Multiplan Commercial |
$5,684.00
|
| Rate for Payer: Networks By Design Commercial |
$3,552.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,039.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,263.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,263.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,666.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2,595.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,326.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,039.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,039.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,039.25
|
|
|
HC REPLC SOCKT SHLDR DIS/INTERC
|
Facility
|
OP
|
$7,105.00
|
|
|
Service Code
|
CPT L6885
|
| Hospital Charge Code |
905356885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$6,039.25 |
| Rate for Payer: Adventist Health Commercial |
$2,913.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,039.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,907.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,328.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,115.22
|
| Rate for Payer: Blue Shield of California Commercial |
$5,243.49
|
| Rate for Payer: Blue Shield of California EPN |
$3,453.03
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Cigna of CA HMO |
$4,973.50
|
| Rate for Payer: Cigna of CA PPO |
$4,973.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,039.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,039.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,039.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,842.00
|
| Rate for Payer: Galaxy Health WC |
$6,039.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,263.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,577.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,739.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,176.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,397.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,705.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,973.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,973.50
|
| Rate for Payer: Multiplan Commercial |
$5,684.00
|
| Rate for Payer: Networks By Design Commercial |
$3,552.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,039.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,263.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,263.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,666.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2,595.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,326.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,039.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,039.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,039.25
|
|
|
HC REPLC TUN CNTRL INSRT CATH W/O
|
Facility
|
IP
|
$10,386.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
909080019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,077.20 |
| Max. Negotiated Rate |
$8,828.10 |
| Rate for Payer: Adventist Health Commercial |
$2,077.20
|
| Rate for Payer: Cash Price |
$4,673.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,154.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,154.40
|
| Rate for Payer: Galaxy Health WC |
$8,828.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,231.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,927.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,957.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,428.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,492.64
|
| Rate for Payer: Multiplan Commercial |
$8,308.80
|
| Rate for Payer: Networks By Design Commercial |
$6,750.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,828.10
|
|
|
HC REPLC TUN CNTRL INSRT CATH W/O
|
Facility
|
OP
|
$10,386.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
909080019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.97 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,077.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$4,673.70
|
| Rate for Payer: Cash Price |
$4,673.70
|
| Rate for Payer: Cash Price |
$4,673.70
|
| Rate for Payer: Cigna of CA HMO |
$6,647.04
|
| Rate for Payer: Cigna of CA PPO |
$7,685.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,828.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,231.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$293.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,927.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,492.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,308.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,750.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,828.10
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,231.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REP LEG TENDON PRIMARY EA
|
Facility
|
IP
|
$8,701.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
900501603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,740.20 |
| Max. Negotiated Rate |
$7,395.85 |
| Rate for Payer: Adventist Health Commercial |
$1,740.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,421.34
|
| Rate for Payer: Blue Shield of California EPN |
$4,228.69
|
| Rate for Payer: Cash Price |
$3,915.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,480.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,480.40
|
| Rate for Payer: Galaxy Health WC |
$7,395.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,220.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,803.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,315.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,385.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,088.24
|
| Rate for Payer: Multiplan Commercial |
$6,960.80
|
| Rate for Payer: Networks By Design Commercial |
$5,655.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,395.85
|
|
|
HC REP LEG TENDON PRIMARY EA
|
Facility
|
OP
|
$8,701.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
900501603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$462.61 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$1,740.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,915.45
|
| Rate for Payer: Cash Price |
$3,915.45
|
| Rate for Payer: Cash Price |
$3,915.45
|
| Rate for Payer: Cigna of CA HMO |
$5,568.64
|
| Rate for Payer: Cigna of CA PPO |
$6,438.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$7,395.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,220.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,803.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,088.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$6,960.80
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$5,655.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,395.85
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,220.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,350.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,350.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,350.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,350.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC REP OF NAIL BED
|
Facility
|
OP
|
$2,031.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$406.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$913.95
|
| Rate for Payer: Cash Price |
$913.95
|
| Rate for Payer: Cash Price |
$913.95
|
| Rate for Payer: Cigna of CA HMO |
$1,299.84
|
| Rate for Payer: Cigna of CA PPO |
$1,502.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,726.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,218.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,354.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,320.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,726.35
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,218.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,015.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,015.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,015.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,015.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP OF NAIL BED
|
Facility
|
IP
|
$2,031.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.20 |
| Max. Negotiated Rate |
$1,726.35 |
| Rate for Payer: Adventist Health Commercial |
$406.20
|
| Rate for Payer: Cash Price |
$913.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$812.40
|
| Rate for Payer: EPIC Health Plan Senior |
$812.40
|
| Rate for Payer: Galaxy Health WC |
$1,726.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,218.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,354.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$773.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,257.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.44
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: Networks By Design Commercial |
$1,320.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,726.35
|
|
|
HC REPOSITION CENTRAL CATH PICC
|
Facility
|
OP
|
$3,241.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$648.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$648.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,990.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,458.45
|
| Rate for Payer: Cash Price |
$1,458.45
|
| Rate for Payer: Cash Price |
$1,458.45
|
| Rate for Payer: Cigna of CA HMO |
$2,074.24
|
| Rate for Payer: Cigna of CA PPO |
$2,398.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$2,754.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,944.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,161.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$2,592.80
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,106.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,754.85
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,944.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REPOSITION CENTRAL CATH PICC
|
Facility
|
OP
|
$3,241.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$648.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$648.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$1,458.45
|
| Rate for Payer: Cash Price |
$1,458.45
|
| Rate for Payer: Cash Price |
$1,458.45
|
| Rate for Payer: Cigna of CA HMO |
$2,074.24
|
| Rate for Payer: Cigna of CA PPO |
$2,398.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$2,754.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,944.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,161.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$2,592.80
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,106.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,754.85
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,944.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,620.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,620.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,620.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,620.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
