|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
OP
|
$4,352.10
|
|
|
Service Code
|
CPT L6713
|
| Hospital Charge Code |
905356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,425.31 |
| Max. Negotiated Rate |
$3,916.89 |
| Rate for Payer: Adventist Health Commercial |
$1,784.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,393.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,264.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,555.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3,364.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,193.46
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Central Health Plan Commercial |
$3,481.68
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,699.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,699.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.84
|
| Rate for Payer: Galaxy Health WC |
$3,699.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,916.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,903.56
|
| Rate for Payer: InnovAge PACE Commercial |
$2,176.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,902.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,102.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,693.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,046.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,046.47
|
| Rate for Payer: Multiplan Commercial |
$3,264.07
|
| Rate for Payer: Networks By Design Commercial |
$2,176.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.28
|
| Rate for Payer: Riverside University Health System MISP |
$1,740.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,611.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,611.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,555.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,699.28
|
| Rate for Payer: Vantage Medical Group Senior |
$3,699.28
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
IP
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
915356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,374.57 |
| Max. Negotiated Rate |
$10,685.57 |
| Rate for Payer: Adventist Health Commercial |
$2,374.57
|
| Rate for Payer: Blue Shield of California Commercial |
$9,177.71
|
| Rate for Payer: Blue Shield of California EPN |
$5,983.92
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Central Health Plan Commercial |
$9,498.28
|
| Rate for Payer: Cigna of CA HMO |
$8,311.00
|
| Rate for Payer: Cigna of CA PPO |
$8,311.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,749.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,749.14
|
| Rate for Payer: Galaxy Health WC |
$10,091.92
|
| Rate for Payer: Global Benefits Group Commercial |
$7,123.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,685.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,919.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,523.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,349.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,374.57
|
| Rate for Payer: Multiplan Commercial |
$8,904.64
|
| Rate for Payer: Networks By Design Commercial |
$7,717.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,455.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4,337.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4,243.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,888.36
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
OP
|
$4,352.10
|
|
|
Service Code
|
CPT L6713
|
| Hospital Charge Code |
915356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,425.31 |
| Max. Negotiated Rate |
$3,916.89 |
| Rate for Payer: Adventist Health Commercial |
$1,784.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,393.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,264.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,555.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3,364.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,193.46
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Central Health Plan Commercial |
$3,481.68
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,699.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,699.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.84
|
| Rate for Payer: Galaxy Health WC |
$3,699.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,916.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,903.56
|
| Rate for Payer: InnovAge PACE Commercial |
$2,176.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,902.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,102.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,693.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,046.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,046.47
|
| Rate for Payer: Multiplan Commercial |
$3,264.07
|
| Rate for Payer: Networks By Design Commercial |
$2,176.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.28
|
| Rate for Payer: Riverside University Health System MISP |
$1,740.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,611.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,611.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,555.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,699.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,699.28
|
| Rate for Payer: Vantage Medical Group Senior |
$3,699.28
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
IP
|
$11,872.85
|
|
|
Service Code
|
CPT L6711
|
| Hospital Charge Code |
905356711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,374.57 |
| Max. Negotiated Rate |
$10,685.57 |
| Rate for Payer: Adventist Health Commercial |
$2,374.57
|
| Rate for Payer: Blue Shield of California Commercial |
$9,177.71
|
| Rate for Payer: Blue Shield of California EPN |
$5,983.92
|
| Rate for Payer: Cash Price |
$6,530.07
|
| Rate for Payer: Central Health Plan Commercial |
$9,498.28
|
| Rate for Payer: Cigna of CA HMO |
$8,311.00
|
| Rate for Payer: Cigna of CA PPO |
$8,311.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,749.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,749.14
|
| Rate for Payer: Galaxy Health WC |
$10,091.92
|
| Rate for Payer: Global Benefits Group Commercial |
$7,123.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,685.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,919.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,523.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,349.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,374.57
|
| Rate for Payer: Multiplan Commercial |
$8,904.64
|
| Rate for Payer: Networks By Design Commercial |
$7,717.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,091.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,455.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4,337.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4,243.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,888.36
|
|
|
HC PED TERM DEV, HOOK, VOL OPEN
|
Facility
|
IP
|
$4,352.10
|
|
|
Service Code
|
CPT L6713
|
| Hospital Charge Code |
915356713
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$870.42 |
| Max. Negotiated Rate |
$3,916.89 |
| Rate for Payer: Adventist Health Commercial |
$870.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,364.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,193.46
|
| Rate for Payer: Cash Price |
$2,393.66
|
| Rate for Payer: Central Health Plan Commercial |
$3,481.68
|
| Rate for Payer: Cigna of CA HMO |
$3,046.47
|
| Rate for Payer: Cigna of CA PPO |
$3,046.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.84
|
| Rate for Payer: Galaxy Health WC |
$3,699.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,916.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,902.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,693.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.42
|
| Rate for Payer: Multiplan Commercial |
$3,264.07
|
| Rate for Payer: Networks By Design Commercial |
$2,828.86
|
| Rate for Payer: Prime Health Services Commercial |
$3,699.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,555.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.31
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.48
|
| Rate for Payer: Blue Shield of California Commercial |
$150.31
|
| Rate for Payer: Blue Shield of California EPN |
$98.15
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: InnovAge PACE Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.00
|
| Rate for Payer: United Healthcare All Other HMO |
$123.00
|
| Rate for Payer: United Healthcare HMO Rider |
$123.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$724.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$710.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$219.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$687.14
|
| Rate for Payer: Blue Shield of California Commercial |
$710.19
|
| Rate for Payer: Blue Shield of California EPN |
$464.49
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Adventist Health Commercial |
$540.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$989.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$774.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,019.59
|
| Rate for Payer: Blue Shield of California EPN |
$664.78
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,121.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,121.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$285.40
|
| Rate for Payer: InnovAge PACE Commercial |
$659.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.30
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Riverside University Health System MISP |
$527.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,121.15
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,019.59
|
| Rate for Payer: Blue Shield of California EPN |
$664.78
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.80
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
915352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Adventist Health Commercial |
$540.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$989.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$774.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,019.59
|
| Rate for Payer: Blue Shield of California EPN |
$664.78
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,121.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,121.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$285.40
|
| Rate for Payer: InnovAge PACE Commercial |
$659.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.30
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Riverside University Health System MISP |
$527.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,121.15
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
915352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,019.59
|
| Rate for Payer: Blue Shield of California EPN |
$664.78
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.80
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
915352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$326.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.49
|
| Rate for Payer: Blue Shield of California Commercial |
$615.31
|
| Rate for Payer: Blue Shield of California EPN |
$401.18
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$676.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.72
|
| Rate for Payer: InnovAge PACE Commercial |
$398.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$557.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Riverside University Health System MISP |
$318.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$326.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.49
|
| Rate for Payer: Blue Shield of California Commercial |
$615.31
|
| Rate for Payer: Blue Shield of California EPN |
$401.18
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$676.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.72
|
| Rate for Payer: InnovAge PACE Commercial |
$398.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$557.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Riverside University Health System MISP |
$318.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
915352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Blue Shield of California Commercial |
$615.31
|
| Rate for Payer: Blue Shield of California EPN |
$401.18
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Blue Shield of California Commercial |
$615.31
|
| Rate for Payer: Blue Shield of California EPN |
$401.18
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
IP
|
$10,380.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,076.00 |
| Max. Negotiated Rate |
$9,342.00 |
| Rate for Payer: Adventist Health Commercial |
$2,076.00
|
| Rate for Payer: Cash Price |
$5,709.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,152.00
|
| Rate for Payer: Galaxy Health WC |
$8,823.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,923.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,954.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,425.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.00
|
| Rate for Payer: Multiplan Commercial |
$7,785.00
|
| Rate for Payer: Networks By Design Commercial |
$6,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,823.00
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
IP
|
$10,380.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,076.00 |
| Max. Negotiated Rate |
$9,342.00 |
| Rate for Payer: Adventist Health Commercial |
$2,076.00
|
| Rate for Payer: Cash Price |
$5,709.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,152.00
|
| Rate for Payer: Galaxy Health WC |
$8,823.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,923.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,954.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,425.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.00
|
| Rate for Payer: Multiplan Commercial |
$7,785.00
|
| Rate for Payer: Networks By Design Commercial |
$6,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,823.00
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$10,380.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$9,342.00 |
| Rate for Payer: Adventist Health Commercial |
$2,076.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$5,709.00
|
| Rate for Payer: Cash Price |
$5,709.00
|
| Rate for Payer: Cash Price |
$5,709.00
|
| Rate for Payer: Cash Price |
$5,709.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,304.00
|
| Rate for Payer: Cigna of CA HMO |
$6,643.20
|
| Rate for Payer: Cigna of CA PPO |
$7,681.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$8,823.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,342.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,923.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$7,785.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$6,747.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$8,823.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,190.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,190.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,190.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,190.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$10,380.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$9,342.00 |
| Rate for Payer: Adventist Health Commercial |
$2,076.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,039.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,342.18
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.62
|
| Rate for Payer: Cash Price |
$5,709.00
|
| Rate for Payer: Cash Price |
$5,709.00
|
| Rate for Payer: Cash Price |
$5,709.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,304.00
|
| Rate for Payer: Cigna of CA HMO |
$6,643.20
|
| Rate for Payer: Cigna of CA PPO |
$7,681.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$8,823.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,342.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,923.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$7,785.00
|
| Rate for Payer: Networks By Design Commercial |
$6,747.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Prime Health Services Commercial |
$8,823.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,228.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,190.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,190.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,190.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,190.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$839.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,105.39
|
| Rate for Payer: Blue Shield of California EPN |
$720.72
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$530.81
|
| Rate for Payer: InnovAge PACE Commercial |
$715.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Riverside University Health System MISP |
$572.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,105.39
|
| Rate for Payer: Blue Shield of California EPN |
$720.72
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$929.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,105.39
|
| Rate for Payer: Blue Shield of California EPN |
$720.72
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$929.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$839.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,105.39
|
| Rate for Payer: Blue Shield of California EPN |
$720.72
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Cash Price |
$786.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$530.81
|
| Rate for Payer: InnovAge PACE Commercial |
$715.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Riverside University Health System MISP |
$572.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
