|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$996.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,164.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,940.56
|
| 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 |
$3,239.60
|
| 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
|
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 |
$3,016.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3,832.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,526.89
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,907.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,164.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,288.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,940.56
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$996.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,164.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,940.56
|
| 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 |
$3,239.60
|
| 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
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT L6588
|
| Hospital Charge Code |
905356588
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,196.16 |
| Max. Negotiated Rate |
$4,236.40 |
| Rate for Payer: Adventist Health Commercial |
$2,043.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,741.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,738.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,016.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3,832.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,526.89
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,907.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,164.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,288.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,940.56
|
| 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 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 |
$2,984.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,791.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,500.02
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,545.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,878.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,909.29
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$986.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,909.29
|
| 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 |
$3,205.15
|
| 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
|
IP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
905356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$986.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$986.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,909.29
|
| 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 |
$3,205.15
|
| 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 |
$2,984.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,791.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,500.02
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,545.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,878.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,909.29
|
| 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
|
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 |
$22,046.84
|
| Rate for Payer: Blue Shield of California Commercial |
$28,009.29
|
| Rate for Payer: Blue Shield of California Commercial |
$18,466.46
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,201.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,128.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,489.57
|
| 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
|
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 |
$22,046.84
|
| Rate for Payer: Blue Shield of California Commercial |
$28,009.29
|
| Rate for Payer: Blue Shield of California Commercial |
$18,466.46
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,201.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,128.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,489.57
|
| 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 |
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 |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$23,128.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,489.57
|
| 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 |
$23,674.95
|
| 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
|
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 |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$23,128.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,489.57
|
| 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 |
$23,674.95
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5,265.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,892.28
|
| 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 |
$5,389.80
|
| 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 |
$5,019.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6,376.55
|
| Rate for Payer: Blue Shield of California Commercial |
$4,204.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,182.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,265.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,892.28
|
| 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
|
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: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| 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 |
$5,019.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6,376.55
|
| Rate for Payer: Blue Shield of California Commercial |
$4,204.04
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cash Price |
$3,731.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,182.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,265.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,892.28
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5,265.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,892.28
|
| 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 |
$5,389.80
|
| 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
|
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 |
$1,463.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,859.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,225.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,042.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,426.62
|
| 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 |
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 |
$1,463.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,859.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,225.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,042.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,426.62
|
| 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 |
915356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,426.62
|
| 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 |
$1,571.70
|
| 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
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
905356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,426.62
|
| 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 |
$1,571.70
|
| 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
|
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 |
$985.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,075.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$975.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$557.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$906.24
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,075.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$975.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$906.24
|
| 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 SEALANT COSEAL 2ML
|
Facility
|
IP
|
$2,046.13
|
|
| Hospital Charge Code |
901605215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$409.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,299.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.22
|
| 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 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 |
$1,238.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,037.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,573.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,299.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$742.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.22
|
| 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 FIBRIN TISSEEL 4ML
|
Facility
|
IP
|
$782.55
|
|
| Hospital Charge Code |
901605213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$156.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.70
|
| 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
|
|
