|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
OP
|
$3,550.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$710.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,130.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,840.00
|
| Rate for Payer: Cigna of CA PPO |
$2,627.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,017.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,195.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,662.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,367.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,662.50
|
| Rate for Payer: Networks By Design Commercial |
$2,307.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,017.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,130.00
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,130.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$510.30 |
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Central Health Plan Commercial |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$510.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$425.25
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$340.20
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Central Health Plan Commercial |
$453.60
|
| Rate for Payer: Cigna of CA PPO |
$419.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$510.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$425.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Innovage PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$425.25
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$340.20
|
| Rate for Payer: Riverside University Health MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$340.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
IP
|
$2,457.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$178,107.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$758.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,306.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$814.71
|
| Rate for Payer: BCBS Transplant Transplant |
$827.40
|
| Rate for Payer: Blue Shield of California Commercial |
$852.22
|
| Rate for Payer: Blue Shield of California EPN |
$670.19
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,103.20
|
| Rate for Payer: Cigna of CA HMO |
$882.56
|
| Rate for Payer: Cigna of CA PPO |
$1,020.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,172.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$551.60
|
| Rate for Payer: Galaxy Health WC |
$1,172.15
|
| Rate for Payer: Global Benefits Group Commercial |
$827.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,241.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,034.25
|
| Rate for Payer: IEHP medi-cal |
$482.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.80
|
| Rate for Payer: Multiplan Commercial |
$1,034.25
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Riverside University Health MISP |
$551.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$827.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$827.40
|
| 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 |
$178,107.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,172.15
|
|
|
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 |
$0.06 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.54
|
| Rate for Payer: BCBS Transplant Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$45.29
|
| Rate for Payer: Blue Shield of California EPN |
$35.21
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| 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: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$54.00
|
| Rate for Payer: IEHP medi-cal |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
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: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
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: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$0.06 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.54
|
| Rate for Payer: BCBS Transplant Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$45.29
|
| Rate for Payer: Blue Shield of California EPN |
$35.21
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| 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: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$54.00
|
| Rate for Payer: IEHP medi-cal |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: Riverside University Health 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 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 |
905356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Blue Shield of California EPN |
$581.53
|
| Rate for Payer: Cash Price |
$490.05
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$217.80
|
| 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
|
|
|
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 |
$381.15 |
| Max. Negotiated Rate |
$2,980.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,980.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$598.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$598.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$527.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.38
|
| Rate for Payer: BCBS Transplant Transplant |
$653.40
|
| Rate for Payer: Blue Shield of California Commercial |
$816.75
|
| Rate for Payer: Blue Shield of California EPN |
$592.42
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| 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: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$816.75
|
| Rate for Payer: IEHP medi-cal |
$381.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$726.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.49
|
| 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 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 |
$544.50
|
| Rate for Payer: United Healthcare All Other HMO |
$544.50
|
| Rate for Payer: United Healthcare HMO Rider |
$544.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Vantage Medical Group Senior |
$925.65
|
|
|
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 |
$3,330.95 |
| Max. Negotiated Rate |
$16,478.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,478.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,234.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,234.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,608.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,622.64
|
| Rate for Payer: BCBS Transplant Transplant |
$5,710.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,137.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,177.25
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cash Price |
$4,282.65
|
| 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: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$7,137.75
|
| Rate for Payer: IEHP medi-cal |
$3,330.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,347.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,901.97
|
| 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 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 |
$4,758.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,758.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,758.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,758.50
|
| 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
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: Blue Shield of California EPN |
$5,082.08
|
| Rate for Payer: Cash Price |
$4,282.65
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$1,903.40
|
| 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
|
|
|
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 |
$2,790.55 |
| Max. Negotiated Rate |
$16,866.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,866.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,385.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,385.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,860.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,710.45
|
| Rate for Payer: BCBS Transplant Transplant |
$4,783.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,979.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,337.31
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cash Price |
$3,587.85
|
| 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: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$5,979.75
|
| Rate for Payer: IEHP medi-cal |
$2,790.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,268.93
|
| 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 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 |
$3,986.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,986.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,986.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,986.50
|
| 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 |
905356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,594.60 |
| Max. Negotiated Rate |
$7,175.70 |
| Rate for Payer: Blue Shield of California EPN |
$4,257.58
|
| Rate for Payer: Cash Price |
$3,587.85
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$1,594.60
|
| 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
|
|
|
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 |
$325.50 |
| Max. Negotiated Rate |
$1,541.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,541.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$511.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$450.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$549.44
|
| Rate for Payer: BCBS Transplant Transplant |
$558.00
|
| Rate for Payer: Blue Shield of California Commercial |
$697.50
|
| Rate for Payer: Blue Shield of California EPN |
$505.92
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$697.50
|
| Rate for Payer: IEHP medi-cal |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.30
|
| 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 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 |
$465.00
|
| Rate for Payer: United Healthcare All Other HMO |
$465.00
|
| Rate for Payer: United Healthcare HMO Rider |
$465.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$465.00
|
| 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 |
905356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Blue Shield of California EPN |
$496.62
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$186.00
|
| 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
|
|
|
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: Blue Shield of California EPN |
$1,035.43
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: Cigna of CA HMO |
$1,357.30
|
| Rate for Payer: Cigna of CA PPO |
$1,357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$387.80
|
| 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
|
|
|
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 |
$678.65 |
| Max. Negotiated Rate |
$8,433.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,433.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,648.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,066.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,066.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$938.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,145.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1,163.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,454.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,054.82
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: Cigna of CA HMO |
$1,357.30
|
| Rate for Payer: Cigna of CA PPO |
$1,357.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,648.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,454.25
|
| Rate for Payer: IEHP medi-cal |
$678.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.99
|
| 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 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 |
$969.50
|
| Rate for Payer: United Healthcare All Other HMO |
$969.50
|
| Rate for Payer: United Healthcare HMO Rider |
$969.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.50
|
| 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 |
$1,744.40 |
| Max. Negotiated Rate |
$12,501.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,501.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,236.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,741.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,741.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,413.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,944.55
|
| Rate for Payer: BCBS Transplant Transplant |
$2,990.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,738.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.30
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,987.20
|
| Rate for Payer: Cigna of CA HMO |
$3,488.80
|
| Rate for Payer: Cigna of CA PPO |
$3,488.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,236.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,993.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3,738.00
|
| Rate for Payer: IEHP medi-cal |
$1,744.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,324.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.44
|
| 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 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 |
$2,492.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,492.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,492.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,492.00
|
| 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: Blue Shield of California EPN |
$2,661.46
|
| Rate for Payer: Cash Price |
$2,242.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,987.20
|
| Rate for Payer: Cigna of CA HMO |
$3,488.80
|
| Rate for Payer: Cigna of CA PPO |
$3,488.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,993.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$996.80
|
| 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
|
|
|
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 |
$1,725.85 |
| Max. Negotiated Rate |
$11,636.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,636.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,191.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,712.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,712.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,387.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,913.23
|
| Rate for Payer: BCBS Transplant Transplant |
$2,958.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,698.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,682.46
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,944.80
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,191.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3,698.25
|
| Rate for Payer: IEHP medi-cal |
$1,725.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,288.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.71
|
| 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 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 |
$2,465.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,465.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.50
|
| 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: Blue Shield of California EPN |
$2,633.15
|
| Rate for Payer: Cash Price |
$2,218.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,944.80
|
| Rate for Payer: Cigna of CA HMO |
$3,451.70
|
| Rate for Payer: Cigna of CA PPO |
$3,451.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,972.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$986.20
|
| 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
|
|
|
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: Blue Shield of California EPN |
$19,449.88
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$7,284.60
|
| 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
|
|
|
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 |
$12,748.05 |
| Max. Negotiated Rate |
$62,686.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62,686.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30,959.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20,032.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20,032.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,636.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,518.71
|
| Rate for Payer: BCBS Transplant Transplant |
$21,853.80
|
| Rate for Payer: Blue Shield of California Commercial |
$27,317.25
|
| Rate for Payer: Blue Shield of California EPN |
$19,814.11
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Cash Price |
$16,390.35
|
| Rate for Payer: Central Health Plan Commercial |
$29,138.40
|
| Rate for Payer: Cigna of CA HMO |
$25,496.10
|
| Rate for Payer: Cigna of CA PPO |
$25,496.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,959.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,569.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$27,317.25
|
| Rate for Payer: IEHP medi-cal |
$12,748.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,294.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,933.43
|
| 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 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 |
$18,211.50
|
| Rate for Payer: United Healthcare All Other HMO |
$18,211.50
|
| Rate for Payer: United Healthcare HMO Rider |
$18,211.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,211.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,959.55
|
| Rate for Payer: Vantage Medical Group Senior |
$30,959.55
|
|
