|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
905356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$304.57 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.98
|
| Rate for Payer: Blue Shield of California Commercial |
$745.86
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Riverside University Health System MISP |
$372.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC SD/IT IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT L6384
|
| Hospital Charge Code |
905356384
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$1,745.10 |
| Rate for Payer: Adventist Health Commercial |
$387.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,555.08
|
| Rate for Payer: Blue Shield of California EPN |
$977.26
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: Cigna of CA HMO |
$1,357.30
|
| Rate for Payer: Cigna of CA PPO |
$1,357.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: EPIC Health Plan Senior |
$775.60
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,745.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,231.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,144.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.80
|
| Rate for Payer: Multiplan Commercial |
$1,454.25
|
| Rate for Payer: Networks By Design Commercial |
$1,260.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$727.71
|
| Rate for Payer: United Healthcare All Other HMO |
$708.32
|
| Rate for Payer: United Healthcare HMO Rider |
$693.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.02
|
|
|
HC SD/IT IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$3,924.00
|
|
|
Service Code
|
CPT L6384
|
| Hospital Charge Code |
915356384
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,285.11 |
| Max. Negotiated Rate |
$3,531.60 |
| Rate for Payer: Networks By Design Commercial |
$1,962.00
|
| Rate for Payer: Adventist Health Commercial |
$1,608.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,335.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,158.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,943.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,282.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,147.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,977.70
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,139.20
|
| Rate for Payer: Cigna of CA HMO |
$2,746.80
|
| Rate for Payer: Cigna of CA PPO |
$2,746.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,335.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,335.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,335.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,746.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,569.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,569.60
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,531.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,894.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,491.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,093.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,315.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,608.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,746.80
|
| Rate for Payer: Multiplan Commercial |
$2,943.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,569.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,354.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,354.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,472.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,433.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,402.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,285.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,335.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,335.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,335.40
|
|
|
HC SD/IT IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT L6384
|
| Hospital Charge Code |
905356384
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$635.02 |
| Max. Negotiated Rate |
$2,093.10 |
| Rate for Payer: Adventist Health Commercial |
$794.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,648.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,066.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,454.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,127.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,555.08
|
| Rate for Payer: Blue Shield of California EPN |
$977.26
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: Cigna of CA HMO |
$1,357.30
|
| Rate for Payer: Cigna of CA PPO |
$1,357.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,648.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,648.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,648.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: EPIC Health Plan Senior |
$775.60
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,745.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,894.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,231.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,093.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,144.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,357.30
|
| Rate for Payer: Multiplan Commercial |
$1,454.25
|
| Rate for Payer: Networks By Design Commercial |
$969.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
| Rate for Payer: Riverside University Health System MISP |
$775.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,163.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,163.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$727.71
|
| Rate for Payer: United Healthcare All Other HMO |
$708.32
|
| Rate for Payer: United Healthcare HMO Rider |
$693.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$635.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,648.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,648.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,648.15
|
|
|
HC SD/IT IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$3,924.00
|
|
|
Service Code
|
CPT L6384
|
| Hospital Charge Code |
915356384
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$784.80 |
| Max. Negotiated Rate |
$3,531.60 |
| Rate for Payer: Adventist Health Commercial |
$784.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,147.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,977.70
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,139.20
|
| Rate for Payer: Cigna of CA HMO |
$2,746.80
|
| Rate for Payer: Cigna of CA PPO |
$2,746.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,746.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,569.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,569.60
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,531.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,491.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,315.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$784.80
|
| Rate for Payer: Multiplan Commercial |
$2,943.00
|
| Rate for Payer: Networks By Design Commercial |
$2,550.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,472.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,433.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,402.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,285.11
|
|
|
HC SD/IT PREP MOLDED TO MODEL
|
Facility
|
IP
|
$4,984.00
|
|
|
Service Code
|
CPT L6588
|
| Hospital Charge Code |
915356588
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.80 |
| Max. Negotiated Rate |
$4,485.60 |
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,987.20
|
| Rate for Payer: Cigna of CA HMO |
$3,488.80
|
| Rate for Payer: Cigna of CA PPO |
$3,488.80
|
| Rate for Payer: Adventist Health Commercial |
$996.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,997.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,488.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,993.60
|
| Rate for Payer: Galaxy Health WC |
$4,236.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,990.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,485.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,164.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,940.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.80
|
| Rate for Payer: Multiplan Commercial |
$3,738.00
|
| Rate for Payer: Networks By Design Commercial |
$3,239.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,236.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,870.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,820.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,632.26
|
|
|
HC SD/IT PREP MOLDED TO MODEL
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT L6588
|
| Hospital Charge Code |
915356588
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,632.26 |
| Max. Negotiated Rate |
$4,485.60 |
| Rate for Payer: Adventist Health Commercial |
$2,043.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,741.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,738.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,899.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,997.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.94
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,987.20
|
| Rate for Payer: Cigna of CA HMO |
$3,488.80
|
| Rate for Payer: Cigna of CA PPO |
$3,488.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,236.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,236.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,488.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,993.60
|
| Rate for Payer: Galaxy Health WC |
$4,236.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,990.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,485.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,976.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,164.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,288.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,940.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,488.80
|
| Rate for Payer: Multiplan Commercial |
$3,738.00
|
| Rate for Payer: Networks By Design Commercial |
$2,492.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,236.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,993.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,990.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,990.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,870.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,820.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,632.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,236.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,236.40
|
|
|
HC SD/IT PREP MOLDED TO MODEL
|
Facility
|
IP
|
$4,984.00
|
|
|
Service Code
|
CPT L6588
|
| Hospital Charge Code |
905356588
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.80 |
| Max. Negotiated Rate |
$4,485.60 |
| Rate for Payer: Adventist Health Commercial |
$996.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,997.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.94
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,987.20
|
| Rate for Payer: Cigna of CA HMO |
$3,488.80
|
| Rate for Payer: Cigna of CA PPO |
$3,488.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,488.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,993.60
|
| Rate for Payer: Galaxy Health WC |
$4,236.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,990.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,485.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,164.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,940.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.80
|
| Rate for Payer: Multiplan Commercial |
$3,738.00
|
| Rate for Payer: Networks By Design Commercial |
$3,239.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,236.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,870.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,820.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,632.26
|
|
|
HC SD/IT PREP MOLDED TO MODEL
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT L6588
|
| Hospital Charge Code |
905356588
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,632.26 |
| Max. Negotiated Rate |
$4,485.60 |
| Rate for Payer: Adventist Health Commercial |
$2,043.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,741.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,738.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,899.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,997.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.94
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,987.20
|
| Rate for Payer: Cigna of CA HMO |
$3,488.80
|
| Rate for Payer: Cigna of CA PPO |
$3,488.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,236.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,236.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,488.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,993.60
|
| Rate for Payer: Galaxy Health WC |
$4,236.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,990.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,485.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,976.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,164.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,288.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,940.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,488.80
|
| Rate for Payer: Multiplan Commercial |
$3,738.00
|
| Rate for Payer: Networks By Design Commercial |
$2,492.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,236.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,993.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,990.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,990.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,870.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,820.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,632.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,236.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,236.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,236.40
|
|
|
HC SD/IT PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
905356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$986.20 |
| Max. Negotiated Rate |
$4,437.90 |
| Rate for Payer: Adventist Health Commercial |
$986.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,954.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,485.22
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,944.80
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,451.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,972.40
|
| Rate for Payer: Galaxy Health WC |
$4,191.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,958.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,437.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,909.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$986.20
|
| Rate for Payer: Multiplan Commercial |
$3,698.25
|
| Rate for Payer: Networks By Design Commercial |
$3,205.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,191.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,801.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,762.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,614.90
|
|
|
HC SD/IT PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
915356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,614.90 |
| Max. Negotiated Rate |
$4,437.90 |
| Rate for Payer: Adventist Health Commercial |
$2,021.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,712.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,698.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,868.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3,954.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,485.22
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,944.80
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,191.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,191.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,451.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,972.40
|
| Rate for Payer: Galaxy Health WC |
$4,191.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,958.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,437.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,605.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,878.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,909.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,451.70
|
| Rate for Payer: Multiplan Commercial |
$3,698.25
|
| Rate for Payer: Networks By Design Commercial |
$2,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,191.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,972.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,958.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,958.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,801.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,762.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,614.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,191.35
|
|
|
HC SD/IT PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
905356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,614.90 |
| Max. Negotiated Rate |
$4,437.90 |
| Rate for Payer: Adventist Health Commercial |
$2,021.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,712.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,698.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,868.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3,954.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,485.22
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,944.80
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,191.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,191.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,451.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,972.40
|
| Rate for Payer: Galaxy Health WC |
$4,191.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,958.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,437.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,605.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,878.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,909.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,451.70
|
| Rate for Payer: Multiplan Commercial |
$3,698.25
|
| Rate for Payer: Networks By Design Commercial |
$2,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,191.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,972.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,958.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,958.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,801.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,762.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,614.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,191.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,191.35
|
|
|
HC SD/IT PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$4,931.00
|
|
|
Service Code
|
CPT L6590
|
| Hospital Charge Code |
915356590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$986.20 |
| Max. Negotiated Rate |
$4,437.90 |
| Rate for Payer: United Healthcare HMO Rider |
$1,762.34
|
| Rate for Payer: Adventist Health Commercial |
$986.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,954.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,485.22
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,944.80
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,451.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,972.40
|
| Rate for Payer: Galaxy Health WC |
$4,191.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,958.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,437.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,909.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$986.20
|
| Rate for Payer: Multiplan Commercial |
$3,698.25
|
| Rate for Payer: Networks By Design Commercial |
$3,205.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,191.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,801.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,614.90
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
IP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
915356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,284.60 |
| Max. Negotiated Rate |
$32,780.70 |
| Rate for Payer: Adventist Health Commercial |
$7,284.60
|
| Rate for Payer: Blue Shield of California Commercial |
$29,211.25
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,780.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,128.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,489.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,284.60
|
| Rate for Payer: Multiplan Commercial |
$27,317.25
|
| Rate for Payer: Networks By Design Commercial |
$23,674.95
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
OP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
905356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,468.10 |
| Max. Negotiated Rate |
$32,780.70 |
| Rate for Payer: Adventist Health Commercial |
$14,933.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,032.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,317.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,187.26
|
| Rate for Payer: Blue Shield of California Commercial |
$29,211.25
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,959.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,959.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,780.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,468.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,128.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,489.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,933.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,496.10
|
| Rate for Payer: Multiplan Commercial |
$27,317.25
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: Riverside University Health System MISP |
$14,569.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,853.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Senior |
$30,959.55
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
OP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
915356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,468.10 |
| Max. Negotiated Rate |
$32,780.70 |
| Rate for Payer: Adventist Health Commercial |
$14,933.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,032.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,317.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,187.26
|
| Rate for Payer: Blue Shield of California Commercial |
$29,211.25
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,959.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,959.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,780.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,468.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,128.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,489.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,933.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,496.10
|
| Rate for Payer: Multiplan Commercial |
$27,317.25
|
| Rate for Payer: Networks By Design Commercial |
$18,211.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: Riverside University Health System MISP |
$14,569.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,853.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,853.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Senior |
$30,959.55
|
|
|
HC SD MECH ELBW MYOELECTRIC CONTR
|
Facility
|
IP
|
$36,423.00
|
|
|
Service Code
|
CPT L6965
|
| Hospital Charge Code |
905356965
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,284.60 |
| Max. Negotiated Rate |
$32,780.70 |
| Rate for Payer: Adventist Health Commercial |
$7,284.60
|
| Rate for Payer: Blue Shield of California Commercial |
$29,211.25
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,569.20
|
| Rate for Payer: Galaxy Health WC |
$30,959.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,853.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,780.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,128.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,489.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,284.60
|
| Rate for Payer: Multiplan Commercial |
$27,317.25
|
| Rate for Payer: Networks By Design Commercial |
$23,674.95
|
| Rate for Payer: Prime Health Services Commercial |
$30,959.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,669.55
|
| Rate for Payer: United Healthcare All Other HMO |
$13,305.32
|
| Rate for Payer: United Healthcare HMO Rider |
$13,017.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,928.53
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
OP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
915356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,715.63 |
| Max. Negotiated Rate |
$7,462.80 |
| Rate for Payer: Adventist Health Commercial |
$3,399.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,560.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,823.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6,650.18
|
| Rate for Payer: Blue Shield of California EPN |
$4,179.17
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,633.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,048.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,048.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,462.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,258.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,265.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,892.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,399.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,804.40
|
| Rate for Payer: Multiplan Commercial |
$6,219.00
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: Riverside University Health System MISP |
$3,316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,048.20
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
IP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
905356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,658.40 |
| Max. Negotiated Rate |
$7,462.80 |
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,650.18
|
| Rate for Payer: Blue Shield of California EPN |
$4,179.17
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,633.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,462.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,265.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,892.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.40
|
| Rate for Payer: Multiplan Commercial |
$6,219.00
|
| Rate for Payer: Networks By Design Commercial |
$5,389.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
IP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
915356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,658.40 |
| Max. Negotiated Rate |
$7,462.80 |
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: Adventist Health Commercial |
$1,658.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,650.18
|
| Rate for Payer: Blue Shield of California EPN |
$4,179.17
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,633.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,462.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,265.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,892.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.40
|
| Rate for Payer: Multiplan Commercial |
$6,219.00
|
| Rate for Payer: Networks By Design Commercial |
$5,389.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
|
|
HC SD PASSIVE RESTORATION
|
Facility
|
OP
|
$8,292.00
|
|
|
Service Code
|
CPT L6310
|
| Hospital Charge Code |
905356310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,715.63 |
| Max. Negotiated Rate |
$7,462.80 |
| Rate for Payer: Adventist Health Commercial |
$3,399.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,560.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,823.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6,650.18
|
| Rate for Payer: Blue Shield of California EPN |
$4,179.17
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Cash Price |
$3,731.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,633.60
|
| Rate for Payer: Cigna of CA HMO |
$5,804.40
|
| Rate for Payer: Cigna of CA PPO |
$5,804.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,048.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,048.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,804.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,316.80
|
| Rate for Payer: Galaxy Health WC |
$7,048.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,462.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,258.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,265.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,599.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,892.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,399.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,804.40
|
| Rate for Payer: Multiplan Commercial |
$6,219.00
|
| Rate for Payer: Networks By Design Commercial |
$4,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,048.20
|
| Rate for Payer: Riverside University Health System MISP |
$3,316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,111.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,029.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,048.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,048.20
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
915356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$791.89 |
| Max. Negotiated Rate |
$2,309.58 |
| Rate for Payer: Dignity Health Medi-Cal |
$2,055.30
|
| Rate for Payer: Adventist Health Commercial |
$991.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,329.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,813.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,406.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,939.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.67
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,055.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,090.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,426.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,692.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Riverside University Health System MISP |
$967.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,055.30
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
905356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,939.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.67
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,426.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
915356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,939.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.67
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,426.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
|
|
HC SD PASSIVE RESTORATN CAP ONLY
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT L6320
|
| Hospital Charge Code |
905356320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$791.89 |
| Max. Negotiated Rate |
$2,309.58 |
| Rate for Payer: Adventist Health Commercial |
$991.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,329.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,813.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,406.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,939.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.67
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Cigna of CA HMO |
$1,692.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,055.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,055.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,090.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,309.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,426.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,692.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
| Rate for Payer: Riverside University Health System MISP |
$967.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,450.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,450.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$907.48
|
| Rate for Payer: United Healthcare All Other HMO |
$883.30
|
| Rate for Payer: United Healthcare HMO Rider |
$864.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,055.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,055.30
|
|
