|
HC SCHILLINGS W/ INTRINSIC FACTOR
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT 78271
|
| Hospital Charge Code |
909301358
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$397.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.09
|
| Rate for Payer: Blue Shield of California Commercial |
$396.98
|
| Rate for Payer: Blue Shield of California EPN |
$259.64
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: Cigna of CA HMO |
$418.56
|
| Rate for Payer: Cigna of CA PPO |
$483.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: InnovAge PACE Commercial |
$327.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Riverside University Health System MISP |
$261.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$327.00
|
| Rate for Payer: United Healthcare All Other HMO |
$327.00
|
| Rate for Payer: United Healthcare HMO Rider |
$327.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SCHILLINGS W/ INTRINSIC FACTOR
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT 78271
|
| Hospital Charge Code |
909301358
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
|
|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$323.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.32
|
| Rate for Payer: Blue Shield of California Commercial |
$405.48
|
| Rate for Payer: Blue Shield of California EPN |
$265.20
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: Cigna of CA HMO |
$427.52
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: InnovAge PACE Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Riverside University Health System MISP |
$267.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.00
|
| Rate for Payer: United Healthcare All Other HMO |
$334.00
|
| Rate for Payer: United Healthcare HMO Rider |
$334.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$334.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
OP
|
$1,358.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$271.60 |
| Max. Negotiated Rate |
$1,222.20 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$824.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,154.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,018.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$657.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$797.55
|
| Rate for Payer: Blue Shield of California Commercial |
$824.31
|
| Rate for Payer: Blue Shield of California EPN |
$539.13
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,086.40
|
| Rate for Payer: Cigna of CA HMO |
$869.12
|
| Rate for Payer: Cigna of CA PPO |
$1,004.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,154.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,154.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,154.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.20
|
| Rate for Payer: EPIC Health Plan Senior |
$543.20
|
| Rate for Payer: Galaxy Health WC |
$1,154.30
|
| Rate for Payer: Global Benefits Group Commercial |
$814.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,222.20
|
| Rate for Payer: InnovAge PACE Commercial |
$679.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$840.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$950.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$950.60
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
| Rate for Payer: Networks By Design Commercial |
$882.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,154.30
|
| Rate for Payer: Riverside University Health System MISP |
$543.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$814.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$814.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$679.00
|
| Rate for Payer: United Healthcare All Other HMO |
$679.00
|
| Rate for Payer: United Healthcare HMO Rider |
$679.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$679.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,154.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,154.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,154.30
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
IP
|
$1,358.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$271.60 |
| Max. Negotiated Rate |
$1,222.20 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.20
|
| Rate for Payer: EPIC Health Plan Senior |
$543.20
|
| Rate for Payer: Galaxy Health WC |
$1,154.30
|
| Rate for Payer: Global Benefits Group Commercial |
$814.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,222.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$840.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.60
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
| Rate for Payer: Networks By Design Commercial |
$882.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,154.30
|
|
|
HC SCL 70 AB
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
|
|
HC SCL 70 AB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$110.79 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.48
|
| Rate for Payer: Blue Shield of California Commercial |
$26.71
|
| Rate for Payer: Blue Shield of California EPN |
$17.47
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: InnovAge PACE Commercial |
$26.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
OP
|
$3,879.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.80 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$775.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,133.45
|
| Rate for Payer: Cash Price |
$2,133.45
|
| Rate for Payer: Cash Price |
$2,133.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,103.20
|
| Rate for Payer: Cigna of CA HMO |
$2,482.56
|
| Rate for Payer: Cigna of CA PPO |
$2,870.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,297.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,327.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,491.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,583.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,587.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$2,909.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,521.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,297.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,327.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
IP
|
$3,879.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.80 |
| Max. Negotiated Rate |
$3,491.10 |
| Rate for Payer: Adventist Health Commercial |
$775.80
|
| Rate for Payer: Cash Price |
$2,133.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,103.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.60
|
| Rate for Payer: Galaxy Health WC |
$3,297.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,327.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,491.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,587.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,477.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,401.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.80
|
| Rate for Payer: Multiplan Commercial |
$2,909.25
|
| Rate for Payer: Networks By Design Commercial |
$2,521.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,297.15
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.02
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Prime Health Services Medicare |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$1,054.80 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Central Health Plan Commercial |
$937.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$468.80
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,054.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$725.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.40
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$3,306.29 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,306.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$688.32
|
| Rate for Payer: Blue Shield of California Commercial |
$711.40
|
| Rate for Payer: Blue Shield of California EPN |
$465.28
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$937.60
|
| Rate for Payer: Cigna of CA HMO |
$750.08
|
| Rate for Payer: Cigna of CA PPO |
$867.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,054.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC SCRNG PRFMD AND NEG LOW RSK
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT G9920
|
| Hospital Charge Code |
902506920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC SCRNG PRFMD AND NEG LOW RSK
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT G9920
|
| Hospital Charge Code |
902506920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.29
|
| Rate for Payer: Blue Shield of California Commercial |
$43.99
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.20
|
| Rate for Payer: InnovAge PACE Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC SCRNG PRFMD AND POS HIGH RSK
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT G9919
|
| Hospital Charge Code |
902506919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC SCRNG PRFMD AND POS HIGH RSK
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT G9919
|
| Hospital Charge Code |
902506919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.29
|
| Rate for Payer: Blue Shield of California Commercial |
$43.99
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.88
|
| Rate for Payer: InnovAge PACE Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
915356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Blue Shield of California Commercial |
$841.80
|
| Rate for Payer: Blue Shield of California EPN |
$548.86
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Central Health Plan Commercial |
$871.20
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$980.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.80
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Networks By Design Commercial |
$707.85
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
915356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$356.65 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Adventist Health Commercial |
$446.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$639.57
|
| Rate for Payer: Blue Shield of California Commercial |
$841.80
|
| Rate for Payer: Blue Shield of California EPN |
$548.86
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Central Health Plan Commercial |
$871.20
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$925.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$925.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$980.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$602.31
|
| Rate for Payer: InnovAge PACE Commercial |
$544.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$762.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$762.30
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Networks By Design Commercial |
$544.50
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: Riverside University Health System MISP |
$435.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$653.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$653.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Vantage Medical Group Senior |
$925.65
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
905356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$356.65 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Adventist Health Commercial |
$446.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$639.57
|
| Rate for Payer: Blue Shield of California Commercial |
$841.80
|
| Rate for Payer: Blue Shield of California EPN |
$548.86
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Central Health Plan Commercial |
$871.20
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$925.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$925.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$980.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$602.31
|
| Rate for Payer: InnovAge PACE Commercial |
$544.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$762.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$762.30
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Networks By Design Commercial |
$544.50
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: Riverside University Health System MISP |
$435.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$653.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$653.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Vantage Medical Group Senior |
$925.65
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
905356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Blue Shield of California Commercial |
$841.80
|
| Rate for Payer: Blue Shield of California EPN |
$548.86
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Central Health Plan Commercial |
$871.20
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$980.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.80
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Networks By Design Commercial |
$707.85
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
IP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
915356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,903.40 |
| Max. Negotiated Rate |
$8,565.30 |
| Rate for Payer: Adventist Health Commercial |
$1,903.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,356.64
|
| Rate for Payer: Blue Shield of California EPN |
$4,796.57
|
| Rate for Payer: Cash Price |
$5,234.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,613.60
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,565.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,625.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,891.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,903.40
|
| Rate for Payer: Multiplan Commercial |
$7,137.75
|
| Rate for Payer: Networks By Design Commercial |
$6,186.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
OP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
915356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,525.34 |
| Max. Negotiated Rate |
$8,565.30 |
| Rate for Payer: Adventist Health Commercial |
$3,901.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,234.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,589.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7,356.64
|
| Rate for Payer: Blue Shield of California EPN |
$4,796.57
|
| Rate for Payer: Cash Price |
$5,234.35
|
| Rate for Payer: Cash Price |
$5,234.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,613.60
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,089.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,089.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,565.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,525.34
|
| Rate for Payer: InnovAge PACE Commercial |
$4,758.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,789.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,891.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,901.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,661.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,661.90
|
| Rate for Payer: Multiplan Commercial |
$7,137.75
|
| Rate for Payer: Networks By Design Commercial |
$4,758.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,806.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,710.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,710.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8,089.45
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
OP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
905356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,525.34 |
| Max. Negotiated Rate |
$8,565.30 |
| Rate for Payer: Adventist Health Commercial |
$3,901.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,234.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,589.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7,356.64
|
| Rate for Payer: Blue Shield of California EPN |
$4,796.57
|
| Rate for Payer: Cash Price |
$5,234.35
|
| Rate for Payer: Cash Price |
$5,234.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,613.60
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,089.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,089.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,565.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,525.34
|
| Rate for Payer: InnovAge PACE Commercial |
$4,758.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,789.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,891.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,901.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,661.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,661.90
|
| Rate for Payer: Multiplan Commercial |
$7,137.75
|
| Rate for Payer: Networks By Design Commercial |
$4,758.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,806.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,710.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,710.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8,089.45
|
|
