|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,059.18 |
| Max. Negotiated Rate |
$8,406.90 |
| Rate for Payer: Adventist Health Commercial |
$3,829.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,137.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,433.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7,491.48
|
| Rate for Payer: Blue Shield of California EPN |
$4,707.86
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,472.80
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,939.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,939.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,406.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,426.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,931.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,511.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,829.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,538.70
|
| Rate for Payer: Multiplan Commercial |
$7,005.75
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,736.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,604.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,604.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,939.85
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,059.18 |
| Max. Negotiated Rate |
$8,406.90 |
| Rate for Payer: Adventist Health Commercial |
$3,829.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,137.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,433.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7,491.48
|
| Rate for Payer: Blue Shield of California EPN |
$4,707.86
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,472.80
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,939.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,939.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,406.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,426.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,931.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,511.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,829.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,538.70
|
| Rate for Payer: Multiplan Commercial |
$7,005.75
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,736.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,604.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,604.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,939.85
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
915355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.12 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Adventist Health Commercial |
$741.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,051.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,450.02
|
| Rate for Payer: Blue Shield of California EPN |
$911.23
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,536.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,536.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,079.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,192.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,265.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Riverside University Health System MISP |
$723.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
915355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: Adventist Health Commercial |
$361.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,450.02
|
| Rate for Payer: Blue Shield of California EPN |
$911.23
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$1,175.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.12 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Adventist Health Commercial |
$741.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,051.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,450.02
|
| Rate for Payer: Blue Shield of California EPN |
$911.23
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,536.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,536.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,079.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,192.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,265.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Riverside University Health System MISP |
$723.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Adventist Health Commercial |
$361.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,450.02
|
| Rate for Payer: Blue Shield of California EPN |
$911.23
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$1,175.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,882.33 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: Adventist Health Commercial |
$3,608.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,119.54
|
| Rate for Payer: Blue Shield of California Commercial |
$7,058.40
|
| Rate for Payer: Blue Shield of California EPN |
$4,435.70
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,480.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,480.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,434.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,588.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,192.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,608.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,160.70
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,520.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,760.20 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: Adventist Health Commercial |
$1,760.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,058.40
|
| Rate for Payer: Blue Shield of California EPN |
$4,435.70
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,588.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,192.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.20
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$5,720.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
915355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,882.33 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: Adventist Health Commercial |
$3,608.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,119.54
|
| Rate for Payer: Blue Shield of California Commercial |
$7,058.40
|
| Rate for Payer: Blue Shield of California EPN |
$4,435.70
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,480.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,480.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,434.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,588.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,192.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,608.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,160.70
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,520.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
915355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,760.20 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: Adventist Health Commercial |
$1,760.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,058.40
|
| Rate for Payer: Blue Shield of California EPN |
$4,435.70
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,588.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,192.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.20
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$5,720.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 1 CHNL
|
Facility
|
OP
|
$2,576.00
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
909100450
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$500.33 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$895.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,344.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$895.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,605.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,232.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,622.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,022.67
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: Cigna of CA HMO |
$1,648.64
|
| Rate for Payer: Cigna of CA PPO |
$1,906.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$985.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,803.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,478.04
|
| Rate for Payer: EPIC Health Plan Senior |
$985.36
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,469.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$895.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,635.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$552.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,200.35
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$895.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
| Rate for Payer: Prime Health Services Medicare |
$949.53
|
| Rate for Payer: Riverside University Health System MISP |
$985.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,545.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,545.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,288.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,288.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$895.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Vantage Medical Group Senior |
$895.78
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 1 CHNL
|
Facility
|
IP
|
$2,576.00
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
909100450
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,803.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,030.40
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,635.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,519.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 2-12 CHNLS
|
Facility
|
OP
|
$2,576.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
909100451
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$4,065.72 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$895.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,448.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$895.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,924.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,065.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,622.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,022.67
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: Cigna of CA HMO |
$1,648.64
|
| Rate for Payer: Cigna of CA PPO |
$1,906.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$985.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,803.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,478.04
|
| Rate for Payer: EPIC Health Plan Senior |
$985.36
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,469.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$930.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$895.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,635.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,027.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,200.35
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$895.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
| Rate for Payer: Prime Health Services Medicare |
$949.53
|
| Rate for Payer: Riverside University Health System MISP |
$985.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,545.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,545.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,288.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,288.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$895.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Vantage Medical Group Senior |
$895.78
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 2-12 CHNLS
|
Facility
|
IP
|
$2,576.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
909100451
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,803.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,030.40
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,635.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,519.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY OVER 12 CHNLS
|
Facility
|
OP
|
$2,576.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
909100452
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$6,415.24 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$895.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,870.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$895.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,614.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,415.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,622.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,022.67
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: Cigna of CA HMO |
$1,648.64
|
| Rate for Payer: Cigna of CA PPO |
$1,906.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$985.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,803.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,478.04
|
| Rate for Payer: EPIC Health Plan Senior |
$985.36
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,469.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,394.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$895.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,635.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,540.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,200.35
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$895.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
| Rate for Payer: Prime Health Services Medicare |
$949.53
|
| Rate for Payer: Riverside University Health System MISP |
$985.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,545.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,545.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,288.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,288.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$895.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Vantage Medical Group Senior |
$895.78
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY OVER 12 CHNLS
|
Facility
|
IP
|
$2,576.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
909100452
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,803.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,030.40
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,635.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,519.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
IP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,723.40 |
| Max. Negotiated Rate |
$16,755.30 |
| Rate for Payer: Adventist Health Commercial |
$3,723.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14,930.83
|
| Rate for Payer: Blue Shield of California EPN |
$9,382.97
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,821.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,984.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,723.40
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$12,101.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
OP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,097.07 |
| Max. Negotiated Rate |
$16,755.30 |
| Rate for Payer: Adventist Health Commercial |
$7,632.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,239.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,962.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,829.51
|
| Rate for Payer: Blue Shield of California Commercial |
$14,930.83
|
| Rate for Payer: Blue Shield of California EPN |
$9,382.97
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,824.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,824.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,783.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,821.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,984.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,632.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,031.90
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: Riverside University Health System MISP |
$7,446.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,170.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,170.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,824.45
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
IP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
915355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,723.40 |
| Max. Negotiated Rate |
$16,755.30 |
| Rate for Payer: Adventist Health Commercial |
$3,723.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14,930.83
|
| Rate for Payer: Blue Shield of California EPN |
$9,382.97
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,821.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,984.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,723.40
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$12,101.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
OP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
915355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,097.07 |
| Max. Negotiated Rate |
$16,755.30 |
| Rate for Payer: Adventist Health Commercial |
$7,632.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,239.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,962.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,829.51
|
| Rate for Payer: Blue Shield of California Commercial |
$14,930.83
|
| Rate for Payer: Blue Shield of California EPN |
$9,382.97
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,824.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,824.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,783.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,821.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,984.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,632.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,031.90
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: Riverside University Health System MISP |
$7,446.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,170.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,170.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,824.45
|
|
|
HC HEAD ECHO
|
Facility
|
IP
|
$1,914.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.80 |
| Max. Negotiated Rate |
$1,722.60 |
| Rate for Payer: Adventist Health Commercial |
$382.80
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,531.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,339.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$765.60
|
| Rate for Payer: Galaxy Health WC |
$1,626.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,722.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,215.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.80
|
| Rate for Payer: Multiplan Commercial |
$1,435.50
|
| Rate for Payer: Networks By Design Commercial |
$1,244.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,626.90
|
|
|
HC HEAD ECHO
|
Facility
|
OP
|
$1,914.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.04 |
| Max. Negotiated Rate |
$1,722.60 |
| Rate for Payer: Adventist Health Commercial |
$382.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$255.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,113.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,205.82
|
| Rate for Payer: Blue Shield of California EPN |
$759.86
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,531.20
|
| Rate for Payer: Cigna of CA HMO |
$1,224.96
|
| Rate for Payer: Cigna of CA PPO |
$1,416.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,339.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,626.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,722.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,215.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,435.50
|
| Rate for Payer: Networks By Design Commercial |
$1,244.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,626.90
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,148.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,148.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC HEAD SCARVES
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Blue Shield of California Commercial |
$39.30
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
|
|
HC HEAD SCARVES
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Blue Shield of California Commercial |
$39.30
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
|
|
HC HEAD SCARVES
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.50
|
| Rate for Payer: Blue Shield of California Commercial |
$39.30
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Riverside University Health System MISP |
$19.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
