|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cigna of CA HMO |
$725.76
|
| Rate for Payer: Cigna of CA PPO |
$839.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$756.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$907.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$680.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$567.00
|
| Rate for Payer: United Healthcare All Other HMO |
$567.00
|
| Rate for Payer: United Healthcare HMO Rider |
$567.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC WEDGE, FOAM, 15 DEGREE. PAIR
|
Facility
|
IP
|
$250.81
|
|
| Hospital Charge Code |
901698446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$213.19 |
| Rate for Payer: Adventist Health Commercial |
$50.16
|
| Rate for Payer: Cash Price |
$137.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.32
|
| Rate for Payer: EPIC Health Plan Senior |
$100.32
|
| Rate for Payer: Galaxy Health WC |
$213.19
|
| Rate for Payer: Global Benefits Group Commercial |
$150.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.19
|
| Rate for Payer: Multiplan Commercial |
$200.65
|
| Rate for Payer: Networks By Design Commercial |
$163.03
|
| Rate for Payer: Prime Health Services Commercial |
$213.19
|
|
|
HC WEDGE, FOAM, 15 DEGREE. PAIR
|
Facility
|
OP
|
$250.81
|
|
| Hospital Charge Code |
901698446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$213.19 |
| Rate for Payer: Adventist Health Commercial |
$50.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$164.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Cash Price |
$137.95
|
| Rate for Payer: Cigna of CA HMO |
$160.52
|
| Rate for Payer: Cigna of CA PPO |
$185.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$213.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.32
|
| Rate for Payer: EPIC Health Plan Senior |
$100.32
|
| Rate for Payer: Galaxy Health WC |
$213.19
|
| Rate for Payer: Global Benefits Group Commercial |
$150.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.57
|
| Rate for Payer: Multiplan Commercial |
$200.65
|
| Rate for Payer: Networks By Design Commercial |
$163.03
|
| Rate for Payer: Prime Health Services Commercial |
$213.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.41
|
| Rate for Payer: United Healthcare All Other HMO |
$125.41
|
| Rate for Payer: United Healthcare HMO Rider |
$125.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.19
|
| Rate for Payer: Vantage Medical Group Senior |
$213.19
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR
|
Facility
|
OP
|
$228.55
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.71 |
| Max. Negotiated Rate |
$194.27 |
| Rate for Payer: Adventist Health Commercial |
$45.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.35
|
| Rate for Payer: Cash Price |
$125.70
|
| Rate for Payer: Cigna of CA HMO |
$146.27
|
| Rate for Payer: Cigna of CA PPO |
$169.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.42
|
| Rate for Payer: EPIC Health Plan Senior |
$91.42
|
| Rate for Payer: Galaxy Health WC |
$194.27
|
| Rate for Payer: Global Benefits Group Commercial |
$137.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$159.99
|
| Rate for Payer: Multiplan Commercial |
$182.84
|
| Rate for Payer: Networks By Design Commercial |
$148.56
|
| Rate for Payer: Prime Health Services Commercial |
$194.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.28
|
| Rate for Payer: United Healthcare All Other HMO |
$114.28
|
| Rate for Payer: United Healthcare HMO Rider |
$114.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.27
|
| Rate for Payer: Vantage Medical Group Senior |
$194.27
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR
|
Facility
|
IP
|
$228.55
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.71 |
| Max. Negotiated Rate |
$194.27 |
| Rate for Payer: Adventist Health Commercial |
$45.71
|
| Rate for Payer: Cash Price |
$125.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.42
|
| Rate for Payer: EPIC Health Plan Senior |
$91.42
|
| Rate for Payer: Galaxy Health WC |
$194.27
|
| Rate for Payer: Global Benefits Group Commercial |
$137.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.85
|
| Rate for Payer: Multiplan Commercial |
$182.84
|
| Rate for Payer: Networks By Design Commercial |
$148.56
|
| Rate for Payer: Prime Health Services Commercial |
$194.27
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR XL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607586
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR XL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607586
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC WEDGE STBLIZR HEELMEDIX
|
Facility
|
OP
|
$41.66
|
|
| Hospital Charge Code |
901606283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Adventist Health Commercial |
$8.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.58
|
| Rate for Payer: Cash Price |
$22.91
|
| Rate for Payer: Cigna of CA HMO |
$26.66
|
| Rate for Payer: Cigna of CA PPO |
$30.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Senior |
$16.66
|
| Rate for Payer: Galaxy Health WC |
$35.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.16
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$35.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.83
|
| Rate for Payer: United Healthcare All Other HMO |
$20.83
|
| Rate for Payer: United Healthcare HMO Rider |
$20.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.41
|
| Rate for Payer: Vantage Medical Group Senior |
$35.41
|
|
|
HC WEDGE STBLIZR HEELMEDIX
|
Facility
|
IP
|
$41.66
|
|
| Hospital Charge Code |
901606283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Adventist Health Commercial |
$8.33
|
| Rate for Payer: Cash Price |
$22.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Senior |
$16.66
|
| Rate for Payer: Galaxy Health WC |
$35.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$35.41
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO |
$541.44
|
| Rate for Payer: Cigna of CA PPO |
$626.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$423.00
|
| Rate for Payer: United Healthcare All Other HMO |
$423.00
|
| Rate for Payer: United Healthcare HMO Rider |
$423.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$523.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.04
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
|
|
HC WEEKLY PHYSICS
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$256.00 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Adventist Health Commercial |
$256.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.00
|
| Rate for Payer: EPIC Health Plan Senior |
$512.00
|
| Rate for Payer: Galaxy Health WC |
$1,088.00
|
| Rate for Payer: Global Benefits Group Commercial |
$768.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$792.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$1,024.00
|
| Rate for Payer: Networks By Design Commercial |
$832.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,088.00
|
|
|
HC WEEKLY PHYSICS
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$92.53 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$256.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$839.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$742.97
|
| Rate for Payer: Blue Shield of California Commercial |
$783.36
|
| Rate for Payer: Blue Shield of California EPN |
$517.12
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cigna of CA HMO |
$819.20
|
| Rate for Payer: Cigna of CA PPO |
$947.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| Rate for Payer: Galaxy Health WC |
$1,088.00
|
| Rate for Payer: Global Benefits Group Commercial |
$768.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| Rate for Payer: Multiplan Commercial |
$1,024.00
|
| Rate for Payer: Networks By Design Commercial |
$832.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,088.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$768.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$168.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC WET MOUNT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC WET MOUNT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC WET MOUNT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$131.12
|
| Rate for Payer: Blue Shield of California EPN |
$86.63
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WET MOUNT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.00
|
| Rate for Payer: United Healthcare All Other HMO |
$98.00
|
| Rate for Payer: United Healthcare HMO Rider |
$98.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$155.55 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.92
|
| Rate for Payer: Multiplan Commercial |
$146.40
|
| Rate for Payer: Networks By Design Commercial |
$118.95
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$75.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cigna of CA HMO |
$117.12
|
| Rate for Payer: Cigna of CA PPO |
$135.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$146.40
|
| Rate for Payer: Networks By Design Commercial |
$118.95
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$75.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cigna of CA HMO |
$117.12
|
| Rate for Payer: Cigna of CA PPO |
$135.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$146.40
|
| Rate for Payer: Networks By Design Commercial |
$118.95
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$155.55 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.92
|
| Rate for Payer: Multiplan Commercial |
$146.40
|
| Rate for Payer: Networks By Design Commercial |
$118.95
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
915363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.85 |
| Rate for Payer: Adventist Health Commercial |
$115.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.76
|
| Rate for Payer: Blue Shield of California Commercial |
$207.38
|
| Rate for Payer: Blue Shield of California EPN |
$136.57
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.70
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
915363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.85 |
| Rate for Payer: Adventist Health Commercial |
$115.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.76
|
| Rate for Payer: Blue Shield of California Commercial |
$207.38
|
| Rate for Payer: Blue Shield of California EPN |
$136.57
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.70
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
