|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
905356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.25 |
| Max. Negotiated Rate |
$1,309.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$800.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$800.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$704.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$859.61
|
| Rate for Payer: Blue Distinction Transplant |
$873.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,091.25
|
| Rate for Payer: Blue Shield of California EPN |
$791.52
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Dignity Health Media |
$1,236.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,236.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,309.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,091.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$509.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.55
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
| Rate for Payer: Networks By Design Commercial |
$727.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Riverside University Health System MISP |
$582.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,236.75
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
905356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,309.50 |
| Rate for Payer: Blue Shield of California EPN |
$776.97
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,309.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
| Rate for Payer: Networks By Design Commercial |
$727.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$549.41
|
| Rate for Payer: United Healthcare All Other HMO |
$536.60
|
| Rate for Payer: United Healthcare HMO Rider |
$524.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.15
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
OP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
905356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,067.00 |
| Max. Negotiated Rate |
$10,458.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,391.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,391.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,626.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,865.10
|
| Rate for Payer: Blue Distinction Transplant |
$6,972.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,715.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,321.28
|
| Rate for Payer: Cash Price |
$5,229.00
|
| Rate for Payer: Cash Price |
$5,229.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,296.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Dignity Health Media |
$9,877.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,877.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,458.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,715.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,067.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,750.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,487.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,764.20
|
| Rate for Payer: Multiplan Commercial |
$8,715.00
|
| Rate for Payer: Networks By Design Commercial |
$5,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,810.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,810.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,810.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,810.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,877.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,877.00
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
IP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
905356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,324.00 |
| Max. Negotiated Rate |
$10,458.00 |
| Rate for Payer: Blue Shield of California EPN |
$6,205.08
|
| Rate for Payer: Cash Price |
$5,229.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,296.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,458.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,750.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,427.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,324.00
|
| Rate for Payer: Multiplan Commercial |
$8,715.00
|
| Rate for Payer: Networks By Design Commercial |
$5,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,387.71
|
| Rate for Payer: United Healthcare All Other HMO |
$4,285.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4,192.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,834.60
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
IP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
905356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,832.20 |
| Max. Negotiated Rate |
$8,244.90 |
| Rate for Payer: Blue Shield of California EPN |
$4,891.97
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,328.80
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,244.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,490.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,832.20
|
| Rate for Payer: Multiplan Commercial |
$6,870.75
|
| Rate for Payer: Networks By Design Commercial |
$4,580.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,459.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3,378.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,023.13
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
OP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
905356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,206.35 |
| Max. Negotiated Rate |
$8,244.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,038.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,038.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,435.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,412.32
|
| Rate for Payer: Blue Distinction Transplant |
$5,496.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,870.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,983.58
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,328.80
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Dignity Health Media |
$7,786.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,786.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,244.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,870.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,206.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,339.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,756.01
|
| Rate for Payer: Multiplan Commercial |
$6,870.75
|
| Rate for Payer: Networks By Design Commercial |
$4,580.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,664.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,496.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,496.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,580.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,580.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,580.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,580.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,786.85
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
OP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
905356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15,295.00 |
| Max. Negotiated Rate |
$42,002.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,667.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,667.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,597.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,572.05
|
| Rate for Payer: Blue Distinction Transplant |
$28,001.40
|
| Rate for Payer: Blue Shield of California Commercial |
$35,001.75
|
| Rate for Payer: Blue Shield of California EPN |
$25,387.94
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Central Health Plan Commercial |
$37,335.20
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Dignity Health Media |
$39,668.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,668.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,002.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$35,001.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,334.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,295.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,134.29
|
| Rate for Payer: Multiplan Commercial |
$35,001.75
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: Riverside University Health System MISP |
$18,667.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,001.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,334.50
|
| Rate for Payer: United Healthcare All Other HMO |
$23,334.50
|
| Rate for Payer: United Healthcare HMO Rider |
$23,334.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23,334.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Senior |
$39,668.65
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
IP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
905356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,333.80 |
| Max. Negotiated Rate |
$42,002.10 |
| Rate for Payer: Blue Shield of California EPN |
$24,921.25
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Central Health Plan Commercial |
$37,335.20
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,002.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,780.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,333.80
|
| Rate for Payer: Multiplan Commercial |
$35,001.75
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,622.21
|
| Rate for Payer: United Healthcare All Other HMO |
$17,211.53
|
| Rate for Payer: United Healthcare HMO Rider |
$16,838.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,400.77
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
IP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
905356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,502.80 |
| Max. Negotiated Rate |
$33,762.60 |
| Rate for Payer: Blue Shield of California EPN |
$20,032.48
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Central Health Plan Commercial |
$30,011.20
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,762.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,292.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,502.80
|
| Rate for Payer: Multiplan Commercial |
$28,135.50
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,165.29
|
| Rate for Payer: United Healthcare All Other HMO |
$13,835.16
|
| Rate for Payer: United Healthcare HMO Rider |
$13,535.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,379.62
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
OP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
905356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,129.90 |
| Max. Negotiated Rate |
$33,762.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,632.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,632.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,164.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,163.27
|
| Rate for Payer: Blue Distinction Transplant |
$22,508.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28,135.50
|
| Rate for Payer: Blue Shield of California EPN |
$20,407.62
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Central Health Plan Commercial |
$30,011.20
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Dignity Health Media |
$31,886.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,886.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,762.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28,135.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,129.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,433.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,380.74
|
| Rate for Payer: Multiplan Commercial |
$28,135.50
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: Riverside University Health System MISP |
$15,005.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,508.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,757.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,757.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,757.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,757.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Senior |
$31,886.90
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
IP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
905356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,981.60 |
| Max. Negotiated Rate |
$8,917.20 |
| Rate for Payer: Blue Shield of California EPN |
$5,290.87
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,926.40
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,917.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,608.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,774.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,981.60
|
| Rate for Payer: Multiplan Commercial |
$7,431.00
|
| Rate for Payer: Networks By Design Commercial |
$4,954.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,741.26
|
| Rate for Payer: United Healthcare All Other HMO |
$3,654.07
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,269.64
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
OP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
905356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,467.80 |
| Max. Negotiated Rate |
$8,917.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,449.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,449.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,797.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,853.65
|
| Rate for Payer: Blue Distinction Transplant |
$5,944.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,431.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,389.95
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,926.40
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Dignity Health Media |
$8,421.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,421.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,917.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,431.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,467.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,608.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,827.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,062.28
|
| Rate for Payer: Multiplan Commercial |
$7,431.00
|
| Rate for Payer: Networks By Design Commercial |
$4,954.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,963.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,944.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,944.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,954.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,954.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,954.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,954.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,421.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,421.80
|
|
|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
905356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,285.20 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,019.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,019.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,777.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,169.42
|
| Rate for Payer: Blue Distinction Transplant |
$2,203.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,754.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,997.57
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,937.60
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,121.20
|
| Rate for Payer: Dignity Health Media |
$3,121.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,121.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,304.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,754.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,285.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,449.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,531.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.52
|
| Rate for Payer: Multiplan Commercial |
$2,754.00
|
| Rate for Payer: Networks By Design Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,468.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,203.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,203.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,836.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,836.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,121.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,121.20
|
|
|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
905356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: Blue Shield of California EPN |
$1,960.85
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,937.60
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,304.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,449.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,399.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.40
|
| Rate for Payer: Multiplan Commercial |
$2,754.00
|
| Rate for Payer: Networks By Design Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,386.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,354.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,211.76
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$525.00
|
| Rate for Payer: Blue Shield of California Commercial |
$550.38
|
| Rate for Payer: Blue Shield of California EPN |
$427.88
|
| Rate for Payer: Caremore Medicare Advantage |
$400.82
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$560.00
|
| Rate for Payer: Cigna of CA PPO |
$647.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$656.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$661.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: InnovAge PACE Commercial |
$601.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Prime Health Services Medicare |
$424.87
|
| Rate for Payer: Riverside University Health System MISP |
$440.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$437.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$525.00
|
| Rate for Payer: Blue Shield of California Commercial |
$550.38
|
| Rate for Payer: Blue Shield of California EPN |
$427.88
|
| Rate for Payer: Caremore Medicare Advantage |
$400.82
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$560.00
|
| Rate for Payer: Cigna of CA PPO |
$647.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$656.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$661.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: InnovAge PACE Commercial |
$601.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Prime Health Services Medicare |
$424.87
|
| Rate for Payer: Riverside University Health System MISP |
$440.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$437.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$525.00
|
| Rate for Payer: Caremore Medicare Advantage |
$400.82
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA PPO |
$647.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$656.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: InnovAge PACE Commercial |
$601.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Prime Health Services Medicare |
$424.87
|
| Rate for Payer: Riverside University Health System MISP |
$440.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$437.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
IP
|
$13,741.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,748.20 |
| Max. Negotiated Rate |
$12,366.90 |
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Central Health Plan Commercial |
$10,992.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.40
|
| Rate for Payer: Galaxy Health WC |
$11,679.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,366.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,235.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,748.20
|
| Rate for Payer: Multiplan Commercial |
$10,305.75
|
| Rate for Payer: Networks By Design Commercial |
$8,931.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.85
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$13,741.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.59 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,244.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Central Health Plan Commercial |
$10,992.80
|
| Rate for Payer: Cigna of CA PPO |
$10,168.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,679.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,366.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,305.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,748.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,305.75
|
| Rate for Payer: Networks By Design Commercial |
$8,931.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,244.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$13,741.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.59 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,244.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Central Health Plan Commercial |
$10,992.80
|
| Rate for Payer: Cigna of CA PPO |
$10,168.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,679.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,366.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,305.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,748.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,305.75
|
| Rate for Payer: Networks By Design Commercial |
$8,931.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,244.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
IP
|
$13,741.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,748.20 |
| Max. Negotiated Rate |
$12,366.90 |
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Central Health Plan Commercial |
$10,992.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.40
|
| Rate for Payer: Galaxy Health WC |
$11,679.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,366.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,235.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,748.20
|
| Rate for Payer: Multiplan Commercial |
$10,305.75
|
| Rate for Payer: Networks By Design Commercial |
$8,931.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.85
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
IP
|
$10,779.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,155.80 |
| Max. Negotiated Rate |
$9,701.10 |
| Rate for Payer: Cash Price |
$4,850.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,623.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,311.60
|
| Rate for Payer: Galaxy Health WC |
$9,162.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,467.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,701.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,189.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,106.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,155.80
|
| Rate for Payer: Multiplan Commercial |
$8,084.25
|
| Rate for Payer: Networks By Design Commercial |
$7,006.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,162.15
|
|
