|
HC SCAPULA
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.94 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$554.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.49
|
| Rate for Payer: Blue Shield of California Commercial |
$517.75
|
| Rate for Payer: Blue Shield of California EPN |
$341.78
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO |
$541.44
|
| Rate for Payer: Cigna of CA PPO |
$626.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SCAPULA
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
|
|
HC SCHILLINGS W/ INTRINSIC FACTOR
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
CPT 78271
|
| Hospital Charge Code |
909301358
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$617.10 |
| Rate for Payer: Adventist Health Commercial |
$145.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$617.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$399.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$544.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.84
|
| Rate for Payer: Blue Shield of California Commercial |
$444.31
|
| Rate for Payer: Blue Shield of California EPN |
$293.30
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna of CA HMO |
$464.64
|
| Rate for Payer: Cigna of CA PPO |
$537.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$617.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$617.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$617.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.40
|
| Rate for Payer: EPIC Health Plan Senior |
$290.40
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.20
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$435.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$363.00
|
| Rate for Payer: United Healthcare All Other HMO |
$363.00
|
| Rate for Payer: United Healthcare HMO Rider |
$363.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$363.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$617.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$617.10
|
| Rate for Payer: Vantage Medical Group Senior |
$617.10
|
|
|
HC SCHILLINGS W/ INTRINSIC FACTOR
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
CPT 78271
|
| Hospital Charge Code |
909301358
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$617.10 |
| Rate for Payer: Adventist Health Commercial |
$145.20
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.40
|
| Rate for Payer: EPIC Health Plan Senior |
$290.40
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.24
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
|
|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$485.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$454.43
|
| Rate for Payer: Blue Shield of California Commercial |
$452.88
|
| Rate for Payer: Blue Shield of California EPN |
$298.96
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cigna of CA HMO |
$473.60
|
| Rate for Payer: Cigna of CA PPO |
$547.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.00
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.00
|
| Rate for Payer: United Healthcare All Other HMO |
$370.00
|
| Rate for Payer: United Healthcare HMO Rider |
$370.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.00
|
| Rate for Payer: Vantage Medical Group Senior |
$629.00
|
|
|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Cash Price |
$827.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$931.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$987.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$827.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,128.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$924.22
|
| Rate for Payer: Blue Shield of California Commercial |
$921.06
|
| Rate for Payer: Blue Shield of California EPN |
$608.02
|
| Rate for Payer: Cash Price |
$827.75
|
| Rate for Payer: Cigna of CA HMO |
$963.20
|
| Rate for Payer: Cigna of CA PPO |
$1,113.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,279.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,279.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$931.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,053.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,053.50
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$903.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$903.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$752.50
|
| Rate for Payer: United Healthcare All Other HMO |
$752.50
|
| Rate for Payer: United Healthcare HMO Rider |
$752.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$752.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,279.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,279.25
|
|
|
HC SCL 70 AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC SCL 70 AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$114.40
|
| Rate for Payer: Blue Shield of California EPN |
$75.58
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cigna of CA HMO |
$2,553.60
|
| Rate for Payer: Cigna of CA PPO |
$2,952.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,546.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,661.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,394.00
|
| 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 |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$3,391.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,596.00
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,661.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,520.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,469.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna of CA HMO |
$284.16
|
| Rate for Payer: Cigna of CA PPO |
$328.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.00
|
| Rate for Payer: United Healthcare All Other HMO |
$222.00
|
| Rate for Payer: United Healthcare HMO Rider |
$222.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Senior |
$177.60
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$437.40 |
| Max. Negotiated Rate |
$1,858.95 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,353.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.88
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,343.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,338.44
|
| Rate for Payer: Blue Shield of California EPN |
$883.55
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cigna of CA HMO |
$1,399.68
|
| Rate for Payer: Cigna of CA PPO |
$1,618.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,312.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,312.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
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 |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| 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 |
$42.35
|
| 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 |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| 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 |
$42.35
|
| 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
|
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 |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| 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 |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| 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
|
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 |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| 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 |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| 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 |
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 |
$5,234.35
|
| Rate for Payer: Cash Price |
$5,234.35
|
| 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
|
|
