|
HC SD/IT PREP MOLDED TO MODEL
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT L6588
|
| Hospital Charge Code |
915356588
|
|
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
|
|
|
HC SD/IT PREP MOLDED TO MODEL
|
Facility
|
IP
|
$4,984.00
|
|
|
Service Code
|
CPT L6588
|
| Hospital Charge Code |
905356588
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$996.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,324.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,898.90
|
| 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: 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: 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
|
|
|
HC SD/IT PREP MOLDED TO MODEL
|
Facility
|
IP
|
$4,984.00
|
|
|
Service Code
|
CPT L6588
|
| Hospital Charge Code |
915356588
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$996.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,324.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,898.90
|
| 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: 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: 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
|
|
|
HC SD/IT PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
905356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$986.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$986.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,972.40
|
| Rate for Payer: Galaxy Health WC |
$4,191.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,958.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,878.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,052.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.44
|
| Rate for Payer: Multiplan Commercial |
$3,944.80
|
| Rate for Payer: Networks By Design Commercial |
$2,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,191.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,801.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,762.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,614.90
|
|
|
HC SD/IT PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
915356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.44 |
| Max. Negotiated Rate |
$4,191.35 |
| Rate for Payer: Adventist Health Commercial |
$2,021.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,712.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,698.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,856.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3,639.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,396.47
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,191.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,191.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,972.40
|
| Rate for Payer: Galaxy Health WC |
$4,191.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,958.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,545.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,878.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,052.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,451.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,451.70
|
| Rate for Payer: Multiplan Commercial |
$3,944.80
|
| Rate for Payer: Networks By Design Commercial |
$2,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,191.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,958.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,958.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,801.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,762.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,614.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,191.35
|
|
|
HC SD/IT PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
915356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$986.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$986.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,972.40
|
| Rate for Payer: Galaxy Health WC |
$4,191.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,958.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,878.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,052.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.44
|
| Rate for Payer: Multiplan Commercial |
$3,944.80
|
| Rate for Payer: Networks By Design Commercial |
$2,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,191.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,801.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,762.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,614.90
|
|
|
HC SD/IT PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
905356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.44 |
| Max. Negotiated Rate |
$4,191.35 |
| Rate for Payer: Adventist Health Commercial |
$2,021.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,712.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,698.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,856.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3,639.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,396.47
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,191.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,191.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,972.40
|
| Rate for Payer: Galaxy Health WC |
$4,191.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,958.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,545.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,878.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,052.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,451.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,451.70
|
| Rate for Payer: Multiplan Commercial |
$3,944.80
|
| Rate for Payer: Networks By Design Commercial |
$2,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,191.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,958.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,958.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,801.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,762.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,614.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,191.35
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
IP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
915356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,284.60 |
| Max. Negotiated Rate |
$30,959.55 |
| Rate for Payer: Adventist Health Commercial |
$7,284.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,877.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,741.52
|
| Rate for Payer: Multiplan Commercial |
$29,138.40
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
OP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
905356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,741.52 |
| Max. Negotiated Rate |
$30,959.55 |
| Rate for Payer: Adventist Health Commercial |
$14,933.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,032.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,317.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,096.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26,880.17
|
| Rate for Payer: Blue Shield of California EPN |
$17,701.58
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,959.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,959.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,201.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,741.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,496.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,496.10
|
| Rate for Payer: Multiplan Commercial |
$29,138.40
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,853.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Senior |
$30,959.55
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
IP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
905356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,284.60 |
| Max. Negotiated Rate |
$30,959.55 |
| Rate for Payer: Adventist Health Commercial |
$7,284.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,877.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,741.52
|
| Rate for Payer: Multiplan Commercial |
$29,138.40
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
OP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
915356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,741.52 |
| Max. Negotiated Rate |
$30,959.55 |
| Rate for Payer: Adventist Health Commercial |
$14,933.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,032.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,317.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,096.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26,880.17
|
| Rate for Payer: Blue Shield of California EPN |
$17,701.58
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,959.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,959.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,201.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,741.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,496.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,496.10
|
| Rate for Payer: Multiplan Commercial |
$29,138.40
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,853.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Senior |
$30,959.55
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
OP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
915356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,990.08 |
| Max. Negotiated Rate |
$7,048.20 |
| Rate for Payer: Adventist Health Commercial |
$3,399.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,560.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,802.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6,119.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,029.91
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,048.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,182.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,804.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,804.40
|
| Rate for Payer: Multiplan Commercial |
$6,633.60
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,048.20
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
IP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
915356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,658.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,159.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.08
|
| Rate for Payer: Multiplan Commercial |
$6,633.60
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
OP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
905356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,990.08 |
| Max. Negotiated Rate |
$7,048.20 |
| Rate for Payer: Adventist Health Commercial |
$3,399.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,560.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,802.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6,119.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,029.91
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,048.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,048.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,182.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,804.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,804.40
|
| Rate for Payer: Multiplan Commercial |
$6,633.60
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,048.20
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
IP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
905356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,658.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,530.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,159.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.08
|
| Rate for Payer: Multiplan Commercial |
$6,633.60
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
915356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
905356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$580.32 |
| Max. Negotiated Rate |
$2,309.58 |
| Rate for Payer: Adventist Health Commercial |
$991.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,329.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,813.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,400.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,784.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,175.15
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,055.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,055.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,042.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,692.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,692.60
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,055.30
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
915356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$580.32 |
| Max. Negotiated Rate |
$2,309.58 |
| Rate for Payer: Adventist Health Commercial |
$991.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,329.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,813.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,400.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,784.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,175.15
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,055.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,055.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,042.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,692.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,692.60
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,055.30
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
905356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.32
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$950.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.64
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,007.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$943.26
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna of CA HMO |
$983.04
|
| Rate for Payer: Cigna of CA PPO |
$1,136.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$950.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.20
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$921.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$921.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Other HMO |
$768.00
|
| Rate for Payer: United Healthcare HMO Rider |
$768.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$768.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC SEALANT COSEAL 2ML
|
Facility
|
OP
|
$2,046.13
|
|
| Hospital Charge Code |
901605215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$1,739.21 |
| Rate for Payer: Adventist Health Commercial |
$409.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,534.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,185.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,510.04
|
| Rate for Payer: Blue Shield of California EPN |
$994.42
|
| Rate for Payer: Cash Price |
$920.76
|
| Rate for Payer: Cigna of CA HMO |
$1,432.29
|
| Rate for Payer: Cigna of CA PPO |
$1,432.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.45
|
| Rate for Payer: EPIC Health Plan Senior |
$818.45
|
| Rate for Payer: Galaxy Health WC |
$1,739.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1,227.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,364.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,266.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,432.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,432.29
|
| Rate for Payer: Multiplan Commercial |
$1,636.90
|
| Rate for Payer: Networks By Design Commercial |
$1,023.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,227.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,227.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$767.91
|
| Rate for Payer: United Healthcare All Other HMO |
$747.45
|
| Rate for Payer: United Healthcare HMO Rider |
$731.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.21
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.21
|
|
|
HC SEALANT COSEAL 2ML
|
Facility
|
IP
|
$2,046.13
|
|
| Hospital Charge Code |
901605215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$409.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$920.76
|
| Rate for Payer: Cash Price |
$920.76
|
| Rate for Payer: Cigna of CA HMO |
$1,432.29
|
| Rate for Payer: Cigna of CA PPO |
$1,432.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.45
|
| Rate for Payer: EPIC Health Plan Senior |
$818.45
|
| Rate for Payer: Galaxy Health WC |
$1,739.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1,227.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,364.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,266.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.07
|
| Rate for Payer: Multiplan Commercial |
$1,636.90
|
| Rate for Payer: Networks By Design Commercial |
$1,023.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$767.91
|
| Rate for Payer: United Healthcare All Other HMO |
$747.45
|
| Rate for Payer: United Healthcare HMO Rider |
$731.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.11
|
|
|
HC SEALANT FIBRIN TISSEEL 4ML
|
Facility
|
OP
|
$782.55
|
|
| Hospital Charge Code |
901605213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$665.17 |
| Rate for Payer: Adventist Health Commercial |
$156.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$665.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.25
|
| Rate for Payer: Blue Shield of California Commercial |
$577.52
|
| Rate for Payer: Blue Shield of California EPN |
$380.32
|
| Rate for Payer: Cash Price |
$352.15
|
| Rate for Payer: Cigna of CA HMO |
$547.78
|
| Rate for Payer: Cigna of CA PPO |
$547.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$665.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$665.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$665.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.02
|
| Rate for Payer: EPIC Health Plan Senior |
$313.02
|
| Rate for Payer: Galaxy Health WC |
$665.17
|
| Rate for Payer: Global Benefits Group Commercial |
$469.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.78
|
| Rate for Payer: Multiplan Commercial |
$626.04
|
| Rate for Payer: Networks By Design Commercial |
$391.27
|
| Rate for Payer: Prime Health Services Commercial |
$665.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.69
|
| Rate for Payer: United Healthcare All Other HMO |
$285.87
|
| Rate for Payer: United Healthcare HMO Rider |
$279.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$665.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$665.17
|
| Rate for Payer: Vantage Medical Group Senior |
$665.17
|
|
|
HC SEALANT FIBRIN TISSEEL 4ML
|
Facility
|
IP
|
$782.55
|
|
| Hospital Charge Code |
901605213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$156.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$352.15
|
| Rate for Payer: Cash Price |
$352.15
|
| Rate for Payer: Cigna of CA HMO |
$547.78
|
| Rate for Payer: Cigna of CA PPO |
$547.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.02
|
| Rate for Payer: EPIC Health Plan Senior |
$313.02
|
| Rate for Payer: Galaxy Health WC |
$665.17
|
| Rate for Payer: Global Benefits Group Commercial |
$469.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.81
|
| Rate for Payer: Multiplan Commercial |
$626.04
|
| Rate for Payer: Networks By Design Commercial |
$391.27
|
| Rate for Payer: Prime Health Services Commercial |
$665.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.69
|
| Rate for Payer: United Healthcare All Other HMO |
$285.87
|
| Rate for Payer: United Healthcare HMO Rider |
$279.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.29
|
|
