|
HC CULTURE UROGENITAL
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC CULTURE WOUND
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911520
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC CULTURE WOUND
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911520
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.70
|
| Rate for Payer: Blue Shield of California Commercial |
$50.99
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.64
|
| Rate for Payer: EPIC Health Plan Senior |
$8.62
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.62
|
| Rate for Payer: InnovAge PACE Commercial |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.55
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.62
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Prime Health Services Medicare |
$9.14
|
| Rate for Payer: Riverside University Health System MISP |
$9.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Vantage Medical Group Senior |
$8.62
|
|
|
HC CULTURE YEAST ID
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
900911555
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.24
|
| Rate for Payer: Blue Shield of California Commercial |
$53.42
|
| Rate for Payer: Blue Shield of California EPN |
$34.94
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.93
|
| Rate for Payer: EPIC Health Plan Senior |
$10.32
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.32
|
| Rate for Payer: InnovAge PACE Commercial |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.83
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.32
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$10.94
|
| Rate for Payer: Riverside University Health System MISP |
$11.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.36
|
| Rate for Payer: United Healthcare All Other HMO |
$8.36
|
| Rate for Payer: United Healthcare HMO Rider |
$8.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.32
|
|
|
HC CULTURE YEAST ID
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
900911555
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC CULTURE YEAST RAPID ID
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912425
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$43.70
|
| Rate for Payer: Blue Shield of California EPN |
$28.58
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE YEAST RAPID ID
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912425
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC CULTURE YERSINIA
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC CULTURE YERSINIA
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.48
|
| Rate for Payer: Blue Shield of California Commercial |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.74
|
| Rate for Payer: EPIC Health Plan Senior |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: InnovAge PACE Commercial |
$14.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.65
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.44
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Medicare |
$10.01
|
| Rate for Payer: Riverside University Health System MISP |
$10.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.65
|
| Rate for Payer: United Healthcare HMO Rider |
$7.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
915356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,442.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
915356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Riverside University Health System MISP |
$887.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
905356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,442.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN FOR CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6696
|
| Hospital Charge Code |
905356696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Riverside University Health System MISP |
$887.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
905356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Riverside University Health System MISP |
$887.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
905356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,442.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
915356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$443.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,442.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
|
|
HC CUS ELBO SKT IN NOT CON/ATYP
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
CPT L6697
|
| Hospital Charge Code |
915356697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$1,997.10 |
| Rate for Payer: Adventist Health Commercial |
$909.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,220.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Cash Price |
$1,220.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,775.20
|
| Rate for Payer: Cigna of CA HMO |
$1,553.30
|
| Rate for Payer: Cigna of CA PPO |
$1,553.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,886.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,886.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.60
|
| Rate for Payer: EPIC Health Plan Senior |
$887.60
|
| Rate for Payer: Galaxy Health WC |
$1,886.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,331.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,997.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,480.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,373.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,553.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,553.30
|
| Rate for Payer: Multiplan Commercial |
$1,664.25
|
| Rate for Payer: Networks By Design Commercial |
$1,109.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,886.15
|
| Rate for Payer: Riverside University Health System MISP |
$887.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,331.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,331.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$832.79
|
| Rate for Payer: United Healthcare All Other HMO |
$810.60
|
| Rate for Payer: United Healthcare HMO Rider |
$793.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,886.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,886.15
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
OP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
915358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,014.45 |
| Max. Negotiated Rate |
$5,535.90 |
| Rate for Payer: Adventist Health Commercial |
$2,521.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,383.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,613.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,612.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4,754.72
|
| Rate for Payer: Blue Shield of California EPN |
$3,100.10
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,920.80
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,228.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,228.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,535.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,777.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3,075.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,521.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,305.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,305.70
|
| Rate for Payer: Multiplan Commercial |
$4,613.25
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,460.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,690.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,228.35
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
OP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
905358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,014.45 |
| Max. Negotiated Rate |
$5,535.90 |
| Rate for Payer: Adventist Health Commercial |
$2,521.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,383.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,613.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,612.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4,754.72
|
| Rate for Payer: Blue Shield of California EPN |
$3,100.10
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,920.80
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,228.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,228.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,535.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,777.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3,075.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,521.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,305.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,305.70
|
| Rate for Payer: Multiplan Commercial |
$4,613.25
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,460.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,690.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,228.35
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
IP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
905358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,230.20 |
| Max. Negotiated Rate |
$5,535.90 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,754.72
|
| Rate for Payer: Blue Shield of California EPN |
$3,100.10
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,920.80
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,535.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,343.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.20
|
| Rate for Payer: Multiplan Commercial |
$4,613.25
|
| Rate for Payer: Networks By Design Commercial |
$3,998.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
IP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
915358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,230.20 |
| Max. Negotiated Rate |
$5,535.90 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,754.72
|
| Rate for Payer: Blue Shield of California EPN |
$3,100.10
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,920.80
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,535.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,343.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.20
|
| Rate for Payer: Multiplan Commercial |
$4,613.25
|
| Rate for Payer: Networks By Design Commercial |
$3,998.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
IP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
905365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$813.40 |
| Max. Negotiated Rate |
$3,660.30 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,253.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,660.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.40
|
| Rate for Payer: Multiplan Commercial |
$3,050.25
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
OP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
915365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$244.98 |
| Max. Negotiated Rate |
$3,660.30 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,469.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,050.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,969.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,388.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,484.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,622.73
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,253.60
|
| Rate for Payer: Cigna of CA HMO |
$2,602.88
|
| Rate for Payer: Cigna of CA PPO |
$3,009.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,456.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,456.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,660.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.98
|
| Rate for Payer: InnovAge PACE Commercial |
$2,033.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,846.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.90
|
| Rate for Payer: Multiplan Commercial |
$3,050.25
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,626.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,440.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,440.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,033.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,033.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,033.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,033.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
IP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
915365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$813.40 |
| Max. Negotiated Rate |
$3,660.30 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,253.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,660.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.40
|
| Rate for Payer: Multiplan Commercial |
$3,050.25
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
OP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
905365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$244.98 |
| Max. Negotiated Rate |
$3,660.30 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,469.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,050.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,969.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,388.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,484.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,622.73
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,253.60
|
| Rate for Payer: Cigna of CA HMO |
$2,602.88
|
| Rate for Payer: Cigna of CA PPO |
$3,009.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,456.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,456.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,660.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.98
|
| Rate for Payer: InnovAge PACE Commercial |
$2,033.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,846.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.90
|
| Rate for Payer: Multiplan Commercial |
$3,050.25
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,626.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,440.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,440.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,033.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,033.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,033.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,033.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,456.95
|
|
