|
HC ADULT/PEDS DIALYSIS TREATMENT
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000300
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$873.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$429.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$980.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,195.78
|
| Rate for Payer: Blue Distinction Transplant |
$1,214.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,273.10
|
| Rate for Payer: Blue Shield of California EPN |
$989.74
|
| Rate for Payer: Caremore Medicare Advantage |
$873.10
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: Cigna of CA HMO |
$1,295.36
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Dignity Health Media |
$873.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.10
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,518.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,431.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,440.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$873.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,309.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.95
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Prime Health Services Medicare |
$925.49
|
| Rate for Payer: Riverside University Health System MISP |
$960.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,012.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,012.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
|
HC ADULT PICC/CVC DRSNG CHNG KIT
|
Facility
|
OP
|
$85.12
|
|
| Hospital Charge Code |
901698284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$76.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.29
|
| Rate for Payer: Blue Distinction Transplant |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$53.54
|
| Rate for Payer: Blue Shield of California EPN |
$41.62
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Central Health Plan Commercial |
$68.10
|
| Rate for Payer: Cigna of CA HMO |
$54.48
|
| Rate for Payer: Cigna of CA PPO |
$62.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.35
|
| Rate for Payer: Dignity Health Media |
$72.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.05
|
| Rate for Payer: Galaxy Health WC |
$72.35
|
| Rate for Payer: Global Benefits Group Commercial |
$51.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$63.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$63.84
|
| Rate for Payer: Networks By Design Commercial |
$55.33
|
| Rate for Payer: Prime Health Services Commercial |
$72.35
|
| Rate for Payer: Riverside University Health System MISP |
$34.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.56
|
| Rate for Payer: United Healthcare All Other HMO |
$42.56
|
| Rate for Payer: United Healthcare HMO Rider |
$42.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.35
|
| Rate for Payer: Vantage Medical Group Senior |
$72.35
|
|
|
HC ADULT PICC/CVC DRSNG CHNG KIT
|
Facility
|
IP
|
$85.12
|
|
| Hospital Charge Code |
901698284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$76.61 |
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Central Health Plan Commercial |
$68.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.05
|
| Rate for Payer: Galaxy Health WC |
$72.35
|
| Rate for Payer: Global Benefits Group Commercial |
$51.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$63.84
|
| Rate for Payer: Networks By Design Commercial |
$55.33
|
| Rate for Payer: Prime Health Services Commercial |
$72.35
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
IP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
905356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,474.80 |
| Max. Negotiated Rate |
$6,636.60 |
| Rate for Payer: Blue Shield of California EPN |
$3,937.72
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,899.20
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,636.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,809.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,474.80
|
| Rate for Payer: Multiplan Commercial |
$5,530.50
|
| Rate for Payer: Networks By Design Commercial |
$3,687.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,784.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,719.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,660.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,433.42
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
OP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
905356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,229.14 |
| Max. Negotiated Rate |
$6,636.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,055.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,055.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,570.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,356.56
|
| Rate for Payer: Blue Distinction Transplant |
$4,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,530.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,011.46
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Cash Price |
$3,318.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,899.20
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Dignity Health Media |
$6,267.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,267.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,636.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,530.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,580.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,229.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,023.34
|
| Rate for Payer: Multiplan Commercial |
$5,530.50
|
| Rate for Payer: Networks By Design Commercial |
$3,687.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,949.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,424.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,424.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,687.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,687.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,687.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,687.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,267.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,267.90
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
905356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.40 |
| Max. Negotiated Rate |
$726.30 |
| Rate for Payer: Blue Shield of California EPN |
$430.94
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Central Health Plan Commercial |
$645.60
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$726.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.40
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: Networks By Design Commercial |
$403.50
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$304.72
|
| Rate for Payer: United Healthcare All Other HMO |
$297.62
|
| Rate for Payer: United Healthcare HMO Rider |
$291.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.31
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
905356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.45 |
| Max. Negotiated Rate |
$726.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$476.78
|
| Rate for Payer: Blue Distinction Transplant |
$484.20
|
| Rate for Payer: Blue Shield of California Commercial |
$605.25
|
| Rate for Payer: Blue Shield of California EPN |
$439.01
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Central Health Plan Commercial |
$645.60
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.95
|
| Rate for Payer: Dignity Health Media |
$685.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$726.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$605.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$282.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.87
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: Networks By Design Commercial |
$403.50
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: Riverside University Health System MISP |
$322.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$403.50
|
| Rate for Payer: United Healthcare All Other HMO |
$403.50
|
| Rate for Payer: United Healthcare HMO Rider |
$403.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.95
|
| Rate for Payer: Vantage Medical Group Senior |
$685.95
|
|
|
HC AE/ED ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6682
|
| Hospital Charge Code |
905356682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$511.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$450.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$549.44
|
| Rate for Payer: Blue Distinction Transplant |
$558.00
|
| Rate for Payer: Blue Shield of California Commercial |
$697.50
|
| Rate for Payer: Blue Shield of California EPN |
$505.92
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Media |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$697.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.30
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Riverside University Health System MISP |
$372.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$465.00
|
| Rate for Payer: United Healthcare All Other HMO |
$465.00
|
| Rate for Payer: United Healthcare HMO Rider |
$465.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$465.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC AE/ED ADDITION TEST SOCKET
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT L6682
|
| Hospital Charge Code |
905356682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Blue Shield of California EPN |
$496.62
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.17
|
| Rate for Payer: United Healthcare All Other HMO |
$342.98
|
| Rate for Payer: United Healthcare HMO Rider |
$335.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.90
|
|
|
HC AE/ED IPOP CAST CHANGE
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
CPT L6388
|
| Hospital Charge Code |
905356388
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$789.30 |
| Rate for Payer: Blue Shield of California EPN |
$468.32
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Central Health Plan Commercial |
$701.60
|
| Rate for Payer: Cigna of CA HMO |
$613.90
|
| Rate for Payer: Cigna of CA PPO |
$613.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$350.80
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$789.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.40
|
| Rate for Payer: Multiplan Commercial |
$657.75
|
| Rate for Payer: Networks By Design Commercial |
$438.50
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.16
|
| Rate for Payer: United Healthcare All Other HMO |
$323.44
|
| Rate for Payer: United Healthcare HMO Rider |
$316.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$289.41
|
|
|
HC AE/ED IPOP CAST CHANGE
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT L6388
|
| Hospital Charge Code |
905356388
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.95 |
| Max. Negotiated Rate |
$789.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$745.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$482.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$482.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$424.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.13
|
| Rate for Payer: Blue Distinction Transplant |
$526.20
|
| Rate for Payer: Blue Shield of California Commercial |
$657.75
|
| Rate for Payer: Blue Shield of California EPN |
$477.09
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Central Health Plan Commercial |
$701.60
|
| Rate for Payer: Cigna of CA HMO |
$613.90
|
| Rate for Payer: Cigna of CA PPO |
$613.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$745.45
|
| Rate for Payer: Dignity Health Media |
$745.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$745.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$350.80
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$789.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$657.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.57
|
| Rate for Payer: Multiplan Commercial |
$657.75
|
| Rate for Payer: Networks By Design Commercial |
$438.50
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| Rate for Payer: Riverside University Health System MISP |
$350.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$438.50
|
| Rate for Payer: United Healthcare All Other HMO |
$438.50
|
| Rate for Payer: United Healthcare HMO Rider |
$438.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$438.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$745.45
|
| Rate for Payer: Vantage Medical Group Senior |
$745.45
|
|
|
HC AE/ED IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$2,610.00
|
|
|
Service Code
|
CPT L6382
|
| Hospital Charge Code |
905356382
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$2,349.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,435.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,435.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,263.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,541.99
|
| Rate for Payer: Blue Distinction Transplant |
$1,566.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,957.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,419.84
|
| Rate for Payer: Cash Price |
$1,174.50
|
| 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: Dignity Health Commercial/Exchange |
$2,218.50
|
| Rate for Payer: Dignity Health Media |
$2,218.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,957.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$913.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,254.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.10
|
| Rate for Payer: Multiplan Commercial |
$1,957.50
|
| Rate for Payer: Networks By Design Commercial |
$1,305.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,044.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,566.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,566.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,305.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,218.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,218.50
|
|
|
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: Blue Shield of California EPN |
$1,393.74
|
| 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: EPIC Health Plan Commercial |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,740.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$994.41
|
| 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 |
$1,305.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,218.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$985.54
|
| Rate for Payer: United Healthcare All Other HMO |
$962.57
|
| Rate for Payer: United Healthcare HMO Rider |
$941.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$861.30
|
|
|
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: Blue Shield of California EPN |
$741.19
|
| 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: EPIC Health Plan Commercial |
$555.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.83
|
| 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 |
$694.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$524.11
|
| Rate for Payer: United Healthcare All Other HMO |
$511.89
|
| Rate for Payer: United Healthcare HMO Rider |
$500.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.04
|
|
|
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 |
$485.80 |
| Max. Negotiated Rate |
$2,210.29 |
| 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 |
$763.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$672.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$820.03
|
| Rate for Payer: Blue Distinction Transplant |
$832.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,041.00
|
| Rate for Payer: Blue Shield of California EPN |
$755.07
|
| 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 Media |
$1,179.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,179.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,041.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$485.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,210.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.08
|
| 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 |
$694.00
|
| Rate for Payer: United Healthcare All Other HMO |
$694.00
|
| Rate for Payer: United Healthcare HMO Rider |
$694.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.00
|
| 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 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: Blue Shield of California EPN |
$1,212.18
|
| 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: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,514.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.87
|
| 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 |
$1,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,929.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$857.15
|
| Rate for Payer: United Healthcare All Other HMO |
$837.18
|
| Rate for Payer: United Healthcare HMO Rider |
$819.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$749.10
|
|
|
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 |
$794.50 |
| Max. Negotiated Rate |
$2,043.00 |
| 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 |
$1,248.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,099.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,341.12
|
| Rate for Payer: Blue Distinction Transplant |
$1,362.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,702.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,234.88
|
| 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 Media |
$1,929.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,929.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,702.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$794.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,514.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,930.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$930.70
|
| 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 |
$1,135.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,135.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,135.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,135.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,929.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,929.50
|
|
|
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: Blue Shield of California EPN |
$2,081.53
|
| 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: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,599.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.14
|
| 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 |
$1,949.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,313.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,471.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1,437.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,406.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,286.34
|
|
|
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 |
$1,364.30 |
| Max. Negotiated Rate |
$3,917.99 |
| 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 |
$2,143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,887.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,302.94
|
| Rate for Payer: Blue Distinction Transplant |
$2,338.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,923.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,120.51
|
| 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 Media |
$3,313.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,313.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,559.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,923.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,364.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,599.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,917.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.18
|
| 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 |
$1,949.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,949.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,949.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,949.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,313.30
|
|
|
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: Blue Shield of California EPN |
$12,066.26
|
| 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: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$15,071.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,609.08
|
| 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 |
$11,298.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,532.25
|
| Rate for Payer: United Healthcare All Other HMO |
$8,333.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8,152.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,456.68
|
|
|
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 |
$7,908.60 |
| Max. Negotiated Rate |
$20,336.40 |
| 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 |
$12,427.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,940.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,349.72
|
| Rate for Payer: Blue Distinction Transplant |
$13,557.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16,947.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,292.22
|
| 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 Media |
$19,206.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,206.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$16,947.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,908.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,071.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,367.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,264.36
|
| 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 |
$11,298.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,298.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,298.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,298.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Senior |
$19,206.60
|
|
|
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: Blue Shield of California EPN |
$15,426.19
|
| 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: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$19,268.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,006.33
|
| 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 |
$14,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,554.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,908.11
|
| Rate for Payer: United Healthcare All Other HMO |
$10,653.89
|
| Rate for Payer: United Healthcare HMO Rider |
$10,422.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,533.04
|
|
|
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 |
$9,999.38 |
| Max. Negotiated Rate |
$25,999.20 |
| 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 |
$15,888.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,987.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,067.03
|
| Rate for Payer: Blue Distinction Transplant |
$17,332.80
|
| Rate for Payer: Blue Shield of California Commercial |
$21,666.00
|
| Rate for Payer: Blue Shield of California EPN |
$15,715.07
|
| 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 Media |
$24,554.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,554.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$21,666.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,268.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,999.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,844.08
|
| 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 |
$14,444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,444.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,554.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,554.80
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$315.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$336.64
|
| Rate for Payer: Cigna of CA PPO |
$389.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$394.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
|
