|
HC SCRNG PRFMD AND NEG LOW RSK
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT G9920
|
| Hospital Charge Code |
902506920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.29
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.90
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.50
|
| Rate for Payer: United Healthcare All Other HMO |
$38.50
|
| Rate for Payer: United Healthcare HMO Rider |
$38.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC SCRNG PRFMD AND NEG LOW RSK
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT G9920
|
| Hospital Charge Code |
902506920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC SCRNG PRFMD AND POS HIGH RSK
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT G9919
|
| Hospital Charge Code |
902506919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.29
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.90
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.50
|
| Rate for Payer: United Healthcare All Other HMO |
$38.50
|
| Rate for Payer: United Healthcare HMO Rider |
$38.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC SCRNG PRFMD AND POS HIGH RSK
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT G9919
|
| Hospital Charge Code |
902506919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
905356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$925.65 |
| Rate for Payer: Adventist Health Commercial |
$446.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.75
|
| Rate for Payer: Blue Shield of California Commercial |
$803.68
|
| Rate for Payer: Blue Shield of California EPN |
$529.25
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$925.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$925.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$588.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$762.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$762.30
|
| Rate for Payer: Multiplan Commercial |
$871.20
|
| Rate for Payer: Networks By Design Commercial |
$544.50
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$653.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$653.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Vantage Medical Group Senior |
$925.65
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
905356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.36
|
| Rate for Payer: Multiplan Commercial |
$871.20
|
| Rate for Payer: Networks By Design Commercial |
$544.50
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
915356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$925.65 |
| Rate for Payer: Adventist Health Commercial |
$446.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.75
|
| Rate for Payer: Blue Shield of California Commercial |
$803.68
|
| Rate for Payer: Blue Shield of California EPN |
$529.25
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$925.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$925.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$588.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$762.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$762.30
|
| Rate for Payer: Multiplan Commercial |
$871.20
|
| Rate for Payer: Networks By Design Commercial |
$544.50
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$653.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$653.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Vantage Medical Group Senior |
$925.65
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
915356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.36
|
| Rate for Payer: Multiplan Commercial |
$871.20
|
| Rate for Payer: Networks By Design Commercial |
$544.50
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
OP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
905356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$8,089.45 |
| Rate for Payer: Adventist Health Commercial |
$3,901.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,234.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,512.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7,023.55
|
| Rate for Payer: Blue Shield of California EPN |
$4,625.26
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,089.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,089.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,466.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,789.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,891.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,661.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,661.90
|
| Rate for Payer: Multiplan Commercial |
$7,613.60
|
| Rate for Payer: Networks By Design Commercial |
$4,758.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,710.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,710.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8,089.45
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
IP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
915356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,903.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$4,758.50
|
| Rate for Payer: Adventist Health Commercial |
$1,903.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,625.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,891.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.08
|
| Rate for Payer: Multiplan Commercial |
$7,613.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
IP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
905356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,903.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,903.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,625.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,891.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.08
|
| Rate for Payer: Multiplan Commercial |
$7,613.60
|
| Rate for Payer: Networks By Design Commercial |
$4,758.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
OP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
915356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$8,089.45 |
| Rate for Payer: Adventist Health Commercial |
$3,901.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,234.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,512.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7,023.55
|
| Rate for Payer: Blue Shield of California EPN |
$4,625.26
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,089.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,089.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,466.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,789.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,891.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,661.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,661.90
|
| Rate for Payer: Multiplan Commercial |
$7,613.60
|
| Rate for Payer: Networks By Design Commercial |
$4,758.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,710.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,710.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8,089.45
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
IP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
915356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,594.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,037.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,935.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.52
|
| Rate for Payer: Multiplan Commercial |
$6,378.40
|
| Rate for Payer: Networks By Design Commercial |
$3,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
OP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
905356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,913.52 |
| Max. Negotiated Rate |
$6,777.05 |
| Rate for Payer: Adventist Health Commercial |
$3,268.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,385.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,979.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,617.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5,884.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,874.88
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,777.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,777.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,023.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,681.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,935.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,581.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,581.10
|
| Rate for Payer: Multiplan Commercial |
$6,378.40
|
| Rate for Payer: Networks By Design Commercial |
$3,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,777.05
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
IP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
905356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,594.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,037.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,935.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.52
|
| Rate for Payer: Multiplan Commercial |
$6,378.40
|
| Rate for Payer: Networks By Design Commercial |
$3,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
OP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
915356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,913.52 |
| Max. Negotiated Rate |
$6,777.05 |
| Rate for Payer: Adventist Health Commercial |
$3,268.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,385.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,979.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,617.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5,884.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,874.88
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,777.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,777.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,023.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,681.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,935.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,581.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,581.10
|
| Rate for Payer: Multiplan Commercial |
$6,378.40
|
| Rate for Payer: Networks By Design Commercial |
$3,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,777.05
|
|
|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
905356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.66
|
| Rate for Payer: Blue Shield of California Commercial |
$686.34
|
| Rate for Payer: Blue Shield of California EPN |
$451.98
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
915356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.66
|
| Rate for Payer: Blue Shield of California Commercial |
$686.34
|
| Rate for Payer: Blue Shield of California EPN |
$451.98
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
915356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
|
|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
905356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
|
|
HC SD/IT IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$3,924.00
|
|
|
Service Code
|
CPT L6384
|
| Hospital Charge Code |
915356384
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$941.76 |
| Max. Negotiated Rate |
$3,335.40 |
| Rate for Payer: Adventist Health Commercial |
$1,608.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,335.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,158.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,943.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,272.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2,895.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.06
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cigna of CA HMO |
$2,746.80
|
| Rate for Payer: Cigna of CA PPO |
$2,746.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,335.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,335.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,335.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,569.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,569.60
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,850.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,093.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,428.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,746.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,746.80
|
| Rate for Payer: Multiplan Commercial |
$3,139.20
|
| Rate for Payer: Networks By Design Commercial |
$1,962.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,354.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,354.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,472.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,433.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,402.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,285.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,335.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,335.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,335.40
|
|
|
HC SD/IT IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT L6384
|
| Hospital Charge Code |
905356384
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$465.36 |
| Max. Negotiated Rate |
$2,093.10 |
| Rate for Payer: Adventist Health Commercial |
$794.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,648.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,066.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,454.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,123.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,430.98
|
| Rate for Payer: Blue Shield of California EPN |
$942.35
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cigna of CA HMO |
$1,357.30
|
| Rate for Payer: Cigna of CA PPO |
$1,357.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,648.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,648.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,648.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: EPIC Health Plan Senior |
$775.60
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,850.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,093.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,200.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,357.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,357.30
|
| Rate for Payer: Multiplan Commercial |
$1,551.20
|
| Rate for Payer: Networks By Design Commercial |
$969.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,163.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,163.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$727.71
|
| Rate for Payer: United Healthcare All Other HMO |
$708.32
|
| Rate for Payer: United Healthcare HMO Rider |
$693.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,648.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,648.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,648.15
|
|
|
HC SD/IT IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$3,924.00
|
|
|
Service Code
|
CPT L6384
|
| Hospital Charge Code |
915356384
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$784.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$784.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cigna of CA HMO |
$2,746.80
|
| Rate for Payer: Cigna of CA PPO |
$2,746.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,569.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,569.60
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,495.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,428.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.76
|
| Rate for Payer: Multiplan Commercial |
$3,139.20
|
| Rate for Payer: Networks By Design Commercial |
$1,962.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,472.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,433.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,402.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,285.11
|
|
|
HC SD/IT IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT L6384
|
| Hospital Charge Code |
905356384
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$387.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cigna of CA HMO |
$1,357.30
|
| Rate for Payer: Cigna of CA PPO |
$1,357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: EPIC Health Plan Senior |
$775.60
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,200.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.36
|
| Rate for Payer: Multiplan Commercial |
$1,551.20
|
| Rate for Payer: Networks By Design Commercial |
$969.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$727.71
|
| Rate for Payer: United Healthcare All Other HMO |
$708.32
|
| Rate for Payer: United Healthcare HMO Rider |
$693.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.02
|
|
|
HC SD/IT PREP MOLDED TO MODEL
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT L6588
|
| Hospital Charge Code |
905356588
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,196.16 |
| Max. Negotiated Rate |
$4,236.40 |
| Rate for Payer: Adventist Health Commercial |
$2,043.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,741.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,738.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,886.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,678.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,422.22
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Cigna of CA HMO |
$3,488.80
|
| Rate for Payer: Cigna of CA PPO |
$3,488.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,236.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,236.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,993.60
|
| Rate for Payer: Galaxy Health WC |
$4,236.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,990.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,907.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,324.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,288.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,085.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,488.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,488.80
|
| Rate for Payer: Multiplan Commercial |
$3,987.20
|
| Rate for Payer: Networks By Design Commercial |
$2,492.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,236.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,990.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,990.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,870.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,820.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,632.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,236.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,236.40
|
|
