|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
IP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
905356300
|
|
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 ENDOSK INCL TISSUE SHAPING
|
Facility
|
OP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
905356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,611.16 |
| Max. Negotiated Rate |
$7,175.70 |
| Rate for Payer: Adventist Health Commercial |
$3,268.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,385.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,979.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,682.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6,163.13
|
| Rate for Payer: Blue Shield of California EPN |
$4,018.39
|
| Rate for Payer: Cash Price |
$4,385.15
|
| Rate for Payer: Cash Price |
$4,385.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,378.40
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,777.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,777.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,175.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,143.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,986.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,681.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,935.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,268.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,581.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,581.10
|
| Rate for Payer: Multiplan Commercial |
$5,979.75
|
| Rate for Payer: Networks By Design Commercial |
$3,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: Riverside University Health System MISP |
$3,189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,777.05
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
IP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
915356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,594.60 |
| Max. Negotiated Rate |
$7,175.70 |
| Rate for Payer: Adventist Health Commercial |
$1,594.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,163.13
|
| Rate for Payer: Blue Shield of California EPN |
$4,018.39
|
| Rate for Payer: Cash Price |
$4,385.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,378.40
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,175.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,037.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,935.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.60
|
| Rate for Payer: Multiplan Commercial |
$5,979.75
|
| Rate for Payer: Networks By Design Commercial |
$5,182.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
IP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
905356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,594.60 |
| Max. Negotiated Rate |
$7,175.70 |
| Rate for Payer: Adventist Health Commercial |
$1,594.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,163.13
|
| Rate for Payer: Blue Shield of California EPN |
$4,018.39
|
| Rate for Payer: Cash Price |
$4,385.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,378.40
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,175.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,037.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,935.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.60
|
| Rate for Payer: Multiplan Commercial |
$5,979.75
|
| Rate for Payer: Networks By Design Commercial |
$5,182.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
OP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
915356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,611.16 |
| Max. Negotiated Rate |
$7,175.70 |
| Rate for Payer: Adventist Health Commercial |
$3,268.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,385.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,979.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,682.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6,163.13
|
| Rate for Payer: Blue Shield of California EPN |
$4,018.39
|
| Rate for Payer: Cash Price |
$4,385.15
|
| Rate for Payer: Cash Price |
$4,385.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,378.40
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,777.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,777.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,175.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,143.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,986.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,681.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,935.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,268.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,581.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,581.10
|
| Rate for Payer: Multiplan Commercial |
$5,979.75
|
| Rate for Payer: Networks By Design Commercial |
$3,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: Riverside University Health System MISP |
$3,189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,777.05
|
|
|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
915356684
|
|
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 |
$546.19
|
| Rate for Payer: Blue Shield of California Commercial |
$718.89
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| 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: 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: InnovAge PACE Commercial |
$465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA 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 ADDITION TEST SOCKET
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
915356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Blue Shield of California Commercial |
$718.89
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$511.50
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| 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
|
|
|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
905356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Blue Shield of California Commercial |
$718.89
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$511.50
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| 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
|
|
|
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 |
$546.19
|
| Rate for Payer: Blue Shield of California Commercial |
$718.89
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| 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: 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: InnovAge PACE Commercial |
$465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,498.85
|
| Rate for Payer: Blue Shield of California EPN |
$977.26
|
| Rate for Payer: Cash Price |
$1,066.45
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,200.24
|
| 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
|
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 |
$3,033.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,977.70
|
| Rate for Payer: Cash Price |
$2,158.20
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,495.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,428.96
|
| 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 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: 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 |
$2,304.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3,033.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,977.70
|
| Rate for Payer: Cash Price |
$2,158.20
|
| Rate for Payer: Cash Price |
$2,158.20
|
| 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: 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: InnovAge PACE Commercial |
$1,962.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,093.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,428.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,608.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,746.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,746.80
|
| Rate for Payer: Multiplan Commercial |
$2,943.00
|
| Rate for Payer: Networks By Design Commercial |
$1,962.00
|
| 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 |
$1,138.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,498.85
|
| Rate for Payer: Blue Shield of California EPN |
$977.26
|
| Rate for Payer: Cash Price |
$1,066.45
|
| Rate for Payer: Cash Price |
$1,066.45
|
| 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: 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: InnovAge PACE Commercial |
$969.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,093.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,200.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,357.30
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$2,927.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3,852.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.94
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cash Price |
$2,741.20
|
| 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: 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: InnovAge PACE Commercial |
$2,492.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,324.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,288.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,085.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,488.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
$3,852.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.94
|
| Rate for Payer: Cash Price |
$2,741.20
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,324.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,898.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,085.10
|
| 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
|
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: Adventist Health Commercial |
$996.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,852.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.94
|
| Rate for Payer: Cash Price |
$2,741.20
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,324.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,898.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,085.10
|
| 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 |
$2,927.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3,852.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.94
|
| Rate for Payer: Cash Price |
$2,741.20
|
| Rate for Payer: Cash Price |
$2,741.20
|
| 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: 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: InnovAge PACE Commercial |
$2,492.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,324.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,288.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,085.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,488.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
915356590
|
|
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 |
$3,811.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,485.22
|
| Rate for Payer: Cash Price |
$2,712.05
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,878.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,052.29
|
| 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 |
$2,895.98
|
| Rate for Payer: Blue Shield of California Commercial |
$3,811.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,485.22
|
| Rate for Payer: Cash Price |
$2,712.05
|
| Rate for Payer: Cash Price |
$2,712.05
|
| 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: 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: InnovAge PACE Commercial |
$2,465.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,878.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,052.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,451.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$3,811.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,485.22
|
| Rate for Payer: Cash Price |
$2,712.05
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,878.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,052.29
|
| 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 |
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 |
$2,895.98
|
| Rate for Payer: Blue Shield of California Commercial |
$3,811.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,485.22
|
| Rate for Payer: Cash Price |
$2,712.05
|
| Rate for Payer: Cash Price |
$2,712.05
|
| 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: 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: InnovAge PACE Commercial |
$2,465.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,878.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,052.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,451.70
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$28,154.98
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$20,032.65
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,877.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| 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 |
$21,391.23
|
| Rate for Payer: Blue Shield of California Commercial |
$28,154.98
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$20,032.65
|
| Rate for Payer: Cash Price |
$20,032.65
|
| 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: 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: InnovAge PACE Commercial |
$18,211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,933.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,496.10
|
| Rate for Payer: Molina Healthcare of CA 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 |
$28,154.98
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$20,032.65
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,877.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| 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 |
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 |
$21,391.23
|
| Rate for Payer: Blue Shield of California Commercial |
$28,154.98
|
| Rate for Payer: Blue Shield of California EPN |
$18,357.19
|
| Rate for Payer: Cash Price |
$20,032.65
|
| Rate for Payer: Cash Price |
$20,032.65
|
| 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: 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: InnovAge PACE Commercial |
$18,211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,668.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,545.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,933.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,496.10
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
