|
HC AE/ED IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$2,610.00
|
|
|
Service Code
|
CPT L6382
|
| Hospital Charge Code |
915356382
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$2,349.00 |
| Rate for Payer: Adventist Health Commercial |
$522.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,093.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,315.44
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,088.00
|
| Rate for Payer: Cigna of CA HMO |
$1,827.00
|
| Rate for Payer: Cigna of CA PPO |
$1,827.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,827.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,349.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,657.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,539.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,957.50
|
| Rate for Payer: Networks By Design Commercial |
$1,696.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.53
|
| Rate for Payer: United Healthcare All Other HMO |
$953.43
|
| Rate for Payer: United Healthcare HMO Rider |
$932.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.77
|
|
|
HC AE/ED IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$2,610.00
|
|
|
Service Code
|
CPT L6382
|
| Hospital Charge Code |
905356382
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$2,349.00 |
| Rate for Payer: Adventist Health Commercial |
$522.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,093.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,315.44
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,088.00
|
| Rate for Payer: Cigna of CA HMO |
$1,827.00
|
| Rate for Payer: Cigna of CA PPO |
$1,827.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,827.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.00
|
| Rate for Payer: Galaxy Health WC |
$2,218.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,349.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,657.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,539.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,957.50
|
| Rate for Payer: Networks By Design Commercial |
$1,696.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.53
|
| Rate for Payer: United Healthcare All Other HMO |
$953.43
|
| Rate for Payer: United Healthcare HMO Rider |
$932.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.77
|
|
|
HC AE/ED PREP MOLDED TO MODEL
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
CPT L6584
|
| Hospital Charge Code |
905356584
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.57 |
| Max. Negotiated Rate |
$2,210.29 |
| Rate for Payer: Adventist Health Commercial |
$569.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,179.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,041.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$807.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,113.18
|
| Rate for Payer: Blue Shield of California EPN |
$699.55
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,110.40
|
| Rate for Payer: Cigna of CA HMO |
$971.60
|
| Rate for Payer: Cigna of CA PPO |
$971.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,179.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,179.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,179.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$971.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$555.20
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,249.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,000.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$881.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,210.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$818.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$971.60
|
| Rate for Payer: Multiplan Commercial |
$1,041.00
|
| Rate for Payer: Networks By Design Commercial |
$694.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
| Rate for Payer: Riverside University Health System MISP |
$555.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$832.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$832.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$520.92
|
| Rate for Payer: United Healthcare All Other HMO |
$507.04
|
| Rate for Payer: United Healthcare HMO Rider |
$496.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$454.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,179.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,179.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,179.80
|
|
|
HC AE/ED PREP MOLDED TO MODEL
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
CPT L6584
|
| Hospital Charge Code |
905356584
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$277.60 |
| Max. Negotiated Rate |
$1,249.20 |
| Rate for Payer: Adventist Health Commercial |
$277.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,113.18
|
| Rate for Payer: Blue Shield of California EPN |
$699.55
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,110.40
|
| Rate for Payer: Cigna of CA HMO |
$971.60
|
| Rate for Payer: Cigna of CA PPO |
$971.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$971.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$555.20
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,249.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$881.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$818.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.60
|
| Rate for Payer: Multiplan Commercial |
$1,041.00
|
| Rate for Payer: Networks By Design Commercial |
$902.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$520.92
|
| Rate for Payer: United Healthcare All Other HMO |
$507.04
|
| Rate for Payer: United Healthcare HMO Rider |
$496.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$454.57
|
|
|
HC AE/ED PREP MOLDED TO MODEL
|
Facility
|
IP
|
$4,156.00
|
|
|
Service Code
|
CPT L6584
|
| Hospital Charge Code |
915356584
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$831.20 |
| Max. Negotiated Rate |
$3,740.40 |
| Rate for Payer: Adventist Health Commercial |
$831.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,333.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.62
|
| Rate for Payer: Cash Price |
$1,870.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.80
|
| Rate for Payer: Cigna of CA HMO |
$2,909.20
|
| Rate for Payer: Cigna of CA PPO |
$2,909.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,909.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.40
|
| Rate for Payer: Galaxy Health WC |
$3,532.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,740.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,639.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,452.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.20
|
| Rate for Payer: Multiplan Commercial |
$3,117.00
|
| Rate for Payer: Networks By Design Commercial |
$2,701.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,532.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,361.09
|
|
|
HC AE/ED PREP MOLDED TO MODEL
|
Facility
|
OP
|
$4,156.00
|
|
|
Service Code
|
CPT L6584
|
| Hospital Charge Code |
915356584
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,361.09 |
| Max. Negotiated Rate |
$3,740.40 |
| Rate for Payer: Networks By Design Commercial |
$2,078.00
|
| Rate for Payer: Adventist Health Commercial |
$1,703.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,532.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,285.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,117.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,417.55
|
| Rate for Payer: Blue Shield of California Commercial |
$3,333.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,094.62
|
| Rate for Payer: Cash Price |
$1,870.20
|
| Rate for Payer: Cash Price |
$1,870.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.80
|
| Rate for Payer: Cigna of CA HMO |
$2,909.20
|
| Rate for Payer: Cigna of CA PPO |
$2,909.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,532.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,532.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,532.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,909.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.40
|
| Rate for Payer: Galaxy Health WC |
$3,532.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,740.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,000.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,639.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,210.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,452.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,703.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,909.20
|
| Rate for Payer: Multiplan Commercial |
$3,117.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,532.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,662.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,493.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,361.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,532.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,532.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,532.60
|
|
|
HC AE/ED PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$2,270.00
|
|
|
Service Code
|
CPT L6586
|
| Hospital Charge Code |
905356586
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.00 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Adventist Health Commercial |
$454.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,820.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,144.08
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,816.00
|
| Rate for Payer: Cigna of CA HMO |
$1,589.00
|
| Rate for Payer: Cigna of CA PPO |
$1,589.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,589.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Senior |
$908.00
|
| Rate for Payer: Galaxy Health WC |
$1,929.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,043.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,441.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,339.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.00
|
| Rate for Payer: Multiplan Commercial |
$1,702.50
|
| Rate for Payer: Networks By Design Commercial |
$1,475.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,929.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.93
|
| Rate for Payer: United Healthcare All Other HMO |
$829.23
|
| Rate for Payer: United Healthcare HMO Rider |
$811.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.42
|
|
|
HC AE/ED PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$2,270.00
|
|
|
Service Code
|
CPT L6586
|
| Hospital Charge Code |
905356586
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$743.42 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Adventist Health Commercial |
$930.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,248.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,702.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,320.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,820.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,144.08
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,816.00
|
| Rate for Payer: Cigna of CA HMO |
$1,589.00
|
| Rate for Payer: Cigna of CA PPO |
$1,589.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,929.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,929.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,589.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Senior |
$908.00
|
| Rate for Payer: Galaxy Health WC |
$1,929.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,043.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,747.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,441.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,930.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,339.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$930.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,589.00
|
| Rate for Payer: Multiplan Commercial |
$1,702.50
|
| Rate for Payer: Networks By Design Commercial |
$1,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,929.50
|
| Rate for Payer: Riverside University Health System MISP |
$908.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,362.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,362.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.93
|
| Rate for Payer: United Healthcare All Other HMO |
$829.23
|
| Rate for Payer: United Healthcare HMO Rider |
$811.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,929.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,929.50
|
|
|
HC AE/ED PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$2,270.00
|
|
|
Service Code
|
CPT L6586
|
| Hospital Charge Code |
915356586
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$743.42 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Adventist Health Commercial |
$930.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,248.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,702.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,320.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,820.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,144.08
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,816.00
|
| Rate for Payer: Cigna of CA HMO |
$1,589.00
|
| Rate for Payer: Cigna of CA PPO |
$1,589.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,929.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,929.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,589.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Senior |
$908.00
|
| Rate for Payer: Galaxy Health WC |
$1,929.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,043.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,747.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,441.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,930.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,339.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$930.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,589.00
|
| Rate for Payer: Multiplan Commercial |
$1,702.50
|
| Rate for Payer: Networks By Design Commercial |
$1,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,929.50
|
| Rate for Payer: Riverside University Health System MISP |
$908.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,362.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,362.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.93
|
| Rate for Payer: United Healthcare All Other HMO |
$829.23
|
| Rate for Payer: United Healthcare HMO Rider |
$811.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,929.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,929.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,929.50
|
|
|
HC AE/ED PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$2,270.00
|
|
|
Service Code
|
CPT L6586
|
| Hospital Charge Code |
915356586
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.00 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Adventist Health Commercial |
$454.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,820.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,144.08
|
| Rate for Payer: Cash Price |
$1,021.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,816.00
|
| Rate for Payer: Cigna of CA HMO |
$1,589.00
|
| Rate for Payer: Cigna of CA PPO |
$1,589.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,589.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Senior |
$908.00
|
| Rate for Payer: Galaxy Health WC |
$1,929.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,362.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,043.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,441.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,339.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.00
|
| Rate for Payer: Multiplan Commercial |
$1,702.50
|
| Rate for Payer: Networks By Design Commercial |
$1,475.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,929.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.93
|
| Rate for Payer: United Healthcare All Other HMO |
$829.23
|
| Rate for Payer: United Healthcare HMO Rider |
$811.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.42
|
|
|
HC AE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$3,898.00
|
|
|
Service Code
|
CPT L6500
|
| Hospital Charge Code |
905356500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,276.60 |
| Max. Negotiated Rate |
$3,917.99 |
| Rate for Payer: Adventist Health Commercial |
$1,598.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,143.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,923.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,267.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,964.59
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,118.40
|
| Rate for Payer: Cigna of CA HMO |
$2,728.60
|
| Rate for Payer: Cigna of CA PPO |
$2,728.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,313.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,313.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,728.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,559.20
|
| Rate for Payer: Galaxy Health WC |
$3,313.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,338.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,508.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,546.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,475.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,917.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,299.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,728.60
|
| Rate for Payer: Multiplan Commercial |
$2,923.50
|
| Rate for Payer: Networks By Design Commercial |
$1,949.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,313.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,559.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,338.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,338.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,423.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,276.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,313.30
|
|
|
HC AE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$3,898.00
|
|
|
Service Code
|
CPT L6500
|
| Hospital Charge Code |
915356500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,276.60 |
| Max. Negotiated Rate |
$3,917.99 |
| Rate for Payer: Networks By Design Commercial |
$1,949.00
|
| Rate for Payer: Adventist Health Commercial |
$1,598.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,143.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,923.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,267.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,964.59
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,118.40
|
| Rate for Payer: Cigna of CA HMO |
$2,728.60
|
| Rate for Payer: Cigna of CA PPO |
$2,728.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,313.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,313.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,728.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,559.20
|
| Rate for Payer: Galaxy Health WC |
$3,313.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,338.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,508.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,546.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,475.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,917.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,299.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,728.60
|
| Rate for Payer: Multiplan Commercial |
$2,923.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,313.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,559.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,338.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,338.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,423.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,276.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,313.30
|
|
|
HC AE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$3,898.00
|
|
|
Service Code
|
CPT L6500
|
| Hospital Charge Code |
915356500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$779.60 |
| Max. Negotiated Rate |
$3,508.20 |
| Rate for Payer: Adventist Health Commercial |
$779.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,964.59
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,118.40
|
| Rate for Payer: Cigna of CA HMO |
$2,728.60
|
| Rate for Payer: Cigna of CA PPO |
$2,728.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,728.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,559.20
|
| Rate for Payer: Galaxy Health WC |
$3,313.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,338.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,508.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,475.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,299.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$779.60
|
| Rate for Payer: Multiplan Commercial |
$2,923.50
|
| Rate for Payer: Networks By Design Commercial |
$2,533.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,313.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,423.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,276.60
|
|
|
HC AE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$3,898.00
|
|
|
Service Code
|
CPT L6500
|
| Hospital Charge Code |
905356500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$779.60 |
| Max. Negotiated Rate |
$3,508.20 |
| Rate for Payer: Adventist Health Commercial |
$779.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,964.59
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,118.40
|
| Rate for Payer: Cigna of CA HMO |
$2,728.60
|
| Rate for Payer: Cigna of CA PPO |
$2,728.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,728.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,559.20
|
| Rate for Payer: Galaxy Health WC |
$3,313.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,338.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,508.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,475.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,299.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$779.60
|
| Rate for Payer: Multiplan Commercial |
$2,923.50
|
| Rate for Payer: Networks By Design Commercial |
$2,533.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,313.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,423.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,276.60
|
|
|
HC AE EXT POWR LOCK ELBW SWTCH CN
|
Facility
|
IP
|
$22,596.00
|
|
|
Service Code
|
CPT L6950
|
| Hospital Charge Code |
905356950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,519.20 |
| Max. Negotiated Rate |
$20,336.40 |
| Rate for Payer: Adventist Health Commercial |
$4,519.20
|
| Rate for Payer: Blue Shield of California Commercial |
$18,121.99
|
| Rate for Payer: Blue Shield of California EPN |
$11,388.38
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Central Health Plan Commercial |
$18,076.80
|
| Rate for Payer: Cigna of CA HMO |
$15,817.20
|
| Rate for Payer: Cigna of CA PPO |
$15,817.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,817.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,038.40
|
| Rate for Payer: Galaxy Health WC |
$19,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,557.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,336.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,348.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,331.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,519.20
|
| Rate for Payer: Multiplan Commercial |
$16,947.00
|
| Rate for Payer: Networks By Design Commercial |
$14,687.40
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,480.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8,254.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8,075.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,400.19
|
|
|
HC AE EXT POWR LOCK ELBW SWTCH CN
|
Facility
|
OP
|
$22,596.00
|
|
|
Service Code
|
CPT L6950
|
| Hospital Charge Code |
905356950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,400.19 |
| Max. Negotiated Rate |
$20,336.40 |
| Rate for Payer: Adventist Health Commercial |
$9,264.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,427.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,947.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,144.09
|
| Rate for Payer: Blue Shield of California Commercial |
$18,121.99
|
| Rate for Payer: Blue Shield of California EPN |
$11,388.38
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Central Health Plan Commercial |
$18,076.80
|
| Rate for Payer: Cigna of CA HMO |
$15,817.20
|
| Rate for Payer: Cigna of CA PPO |
$15,817.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,206.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,206.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,817.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,038.40
|
| Rate for Payer: Galaxy Health WC |
$19,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,557.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,336.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,575.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,348.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,367.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,331.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,264.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,817.20
|
| Rate for Payer: Multiplan Commercial |
$16,947.00
|
| Rate for Payer: Networks By Design Commercial |
$11,298.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: Riverside University Health System MISP |
$9,038.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,557.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,557.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,480.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8,254.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8,075.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,400.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Senior |
$19,206.60
|
|
|
HC AE EXT POWR LOCK ELBW SWTCH CN
|
Facility
|
OP
|
$22,596.00
|
|
|
Service Code
|
CPT L6950
|
| Hospital Charge Code |
915356950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,400.19 |
| Max. Negotiated Rate |
$20,336.40 |
| Rate for Payer: Adventist Health Commercial |
$9,264.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,427.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,947.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,144.09
|
| Rate for Payer: Blue Shield of California Commercial |
$18,121.99
|
| Rate for Payer: Blue Shield of California EPN |
$11,388.38
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Central Health Plan Commercial |
$18,076.80
|
| Rate for Payer: Cigna of CA HMO |
$15,817.20
|
| Rate for Payer: Cigna of CA PPO |
$15,817.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,206.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,206.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,817.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,038.40
|
| Rate for Payer: Galaxy Health WC |
$19,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,557.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,336.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,575.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,348.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,367.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,331.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,264.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,817.20
|
| Rate for Payer: Multiplan Commercial |
$16,947.00
|
| Rate for Payer: Networks By Design Commercial |
$11,298.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: Riverside University Health System MISP |
$9,038.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,557.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,557.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,480.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8,254.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8,075.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,400.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Senior |
$19,206.60
|
|
|
HC AE EXT POWR LOCK ELBW SWTCH CN
|
Facility
|
IP
|
$22,596.00
|
|
|
Service Code
|
CPT L6950
|
| Hospital Charge Code |
915356950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,519.20 |
| Max. Negotiated Rate |
$20,336.40 |
| Rate for Payer: Adventist Health Commercial |
$4,519.20
|
| Rate for Payer: Blue Shield of California Commercial |
$18,121.99
|
| Rate for Payer: Blue Shield of California EPN |
$11,388.38
|
| Rate for Payer: Cash Price |
$10,168.20
|
| Rate for Payer: Central Health Plan Commercial |
$18,076.80
|
| Rate for Payer: Cigna of CA HMO |
$15,817.20
|
| Rate for Payer: Cigna of CA PPO |
$15,817.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,817.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,038.40
|
| Rate for Payer: Galaxy Health WC |
$19,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,557.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,336.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,348.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,331.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,519.20
|
| Rate for Payer: Multiplan Commercial |
$16,947.00
|
| Rate for Payer: Networks By Design Commercial |
$14,687.40
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,480.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8,254.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8,075.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,400.19
|
|
|
HC AE EXT PWR LOCK ELBW MYOELECTR
|
Facility
|
IP
|
$28,888.00
|
|
|
Service Code
|
CPT L6955
|
| Hospital Charge Code |
915356955
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,777.60 |
| Max. Negotiated Rate |
$25,999.20 |
| Rate for Payer: Cash Price |
$12,999.60
|
| Rate for Payer: Adventist Health Commercial |
$5,777.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23,168.18
|
| Rate for Payer: Blue Shield of California EPN |
$14,559.55
|
| Rate for Payer: Central Health Plan Commercial |
$23,110.40
|
| Rate for Payer: Cigna of CA HMO |
$20,221.60
|
| Rate for Payer: Cigna of CA PPO |
$20,221.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,221.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,555.20
|
| Rate for Payer: Galaxy Health WC |
$24,554.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,332.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,999.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,343.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,043.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,777.60
|
| Rate for Payer: Multiplan Commercial |
$21,666.00
|
| Rate for Payer: Networks By Design Commercial |
$18,777.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,554.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,841.67
|
| Rate for Payer: United Healthcare All Other HMO |
$10,552.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10,324.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,460.82
|
|
|
HC AE EXT PWR LOCK ELBW MYOELECTR
|
Facility
|
OP
|
$28,888.00
|
|
|
Service Code
|
CPT L6955
|
| Hospital Charge Code |
905356955
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,052.07 |
| Max. Negotiated Rate |
$25,999.20 |
| Rate for Payer: Adventist Health Commercial |
$11,844.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,888.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,666.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,804.15
|
| Rate for Payer: Blue Shield of California Commercial |
$23,168.18
|
| Rate for Payer: Blue Shield of California EPN |
$14,559.55
|
| Rate for Payer: Cash Price |
$12,999.60
|
| Rate for Payer: Cash Price |
$12,999.60
|
| Rate for Payer: Central Health Plan Commercial |
$23,110.40
|
| Rate for Payer: Cigna of CA HMO |
$20,221.60
|
| Rate for Payer: Cigna of CA PPO |
$20,221.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,554.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,554.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,221.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,555.20
|
| Rate for Payer: Galaxy Health WC |
$24,554.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,332.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,999.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,052.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,343.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,999.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,043.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,844.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,221.60
|
| Rate for Payer: Multiplan Commercial |
$21,666.00
|
| Rate for Payer: Networks By Design Commercial |
$14,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,554.80
|
| Rate for Payer: Riverside University Health System MISP |
$11,555.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,332.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,332.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,841.67
|
| Rate for Payer: United Healthcare All Other HMO |
$10,552.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10,324.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,460.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,554.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,554.80
|
|
|
HC AE EXT PWR LOCK ELBW MYOELECTR
|
Facility
|
OP
|
$28,888.00
|
|
|
Service Code
|
CPT L6955
|
| Hospital Charge Code |
915356955
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,052.07 |
| Max. Negotiated Rate |
$25,999.20 |
| Rate for Payer: Adventist Health Commercial |
$11,844.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,888.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,666.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,804.15
|
| Rate for Payer: Blue Shield of California Commercial |
$23,168.18
|
| Rate for Payer: Blue Shield of California EPN |
$14,559.55
|
| Rate for Payer: Cash Price |
$12,999.60
|
| Rate for Payer: Cash Price |
$12,999.60
|
| Rate for Payer: Central Health Plan Commercial |
$23,110.40
|
| Rate for Payer: Cigna of CA HMO |
$20,221.60
|
| Rate for Payer: Cigna of CA PPO |
$20,221.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,554.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,554.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,221.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,555.20
|
| Rate for Payer: Galaxy Health WC |
$24,554.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,332.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,999.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,052.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,343.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,999.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,043.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,844.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,221.60
|
| Rate for Payer: Multiplan Commercial |
$21,666.00
|
| Rate for Payer: Networks By Design Commercial |
$14,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,554.80
|
| Rate for Payer: Riverside University Health System MISP |
$11,555.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,332.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,332.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,841.67
|
| Rate for Payer: United Healthcare All Other HMO |
$10,552.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10,324.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,460.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,554.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,554.80
|
|
|
HC AE EXT PWR LOCK ELBW MYOELECTR
|
Facility
|
IP
|
$28,888.00
|
|
|
Service Code
|
CPT L6955
|
| Hospital Charge Code |
905356955
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,777.60 |
| Max. Negotiated Rate |
$25,999.20 |
| Rate for Payer: Adventist Health Commercial |
$5,777.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23,168.18
|
| Rate for Payer: Blue Shield of California EPN |
$14,559.55
|
| Rate for Payer: Cash Price |
$12,999.60
|
| Rate for Payer: Central Health Plan Commercial |
$23,110.40
|
| Rate for Payer: Cigna of CA HMO |
$20,221.60
|
| Rate for Payer: Cigna of CA PPO |
$20,221.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,221.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,555.20
|
| Rate for Payer: Galaxy Health WC |
$24,554.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,332.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,999.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,343.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,043.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,777.60
|
| Rate for Payer: Multiplan Commercial |
$21,666.00
|
| Rate for Payer: Networks By Design Commercial |
$18,777.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,554.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,841.67
|
| Rate for Payer: United Healthcare All Other HMO |
$10,552.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10,324.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,460.82
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$281.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$368.00
|
| Rate for Payer: Cigna of CA PPO |
$425.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$402.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.71
|
| Rate for Payer: EPIC Health Plan Senior |
$309.80
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$461.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$365.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$281.64
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
| Rate for Payer: Prime Health Services Medicare |
$298.54
|
| Rate for Payer: Riverside University Health System MISP |
$309.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$281.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$402.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$230.00
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$365.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$339.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
|
|
HC AERO INHAL MDI/DPI SUB
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$281.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$368.00
|
| Rate for Payer: Cigna of CA PPO |
$425.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$402.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.71
|
| Rate for Payer: EPIC Health Plan Senior |
$309.80
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$461.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$365.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$281.64
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
| Rate for Payer: Prime Health Services Medicare |
$298.54
|
| Rate for Payer: Riverside University Health System MISP |
$309.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$281.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
