|
HC ANGIO JET THROM CATH 105CM
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$980.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,245.78
|
| Rate for Payer: Blue Shield of California Commercial |
$821.34
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC ANGIO JET THROM CATH 105CM
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
|
|
HC ANGIO JET THROM CATH 140CM
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna of CA HMO |
$2,058.00
|
| Rate for Payer: Cigna of CA PPO |
$2,058.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,103.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.85
|
|
|
HC ANGIO JET THROM CATH 140CM
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,617.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,205.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,779.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,490.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,260.86
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna of CA HMO |
$2,058.00
|
| Rate for Payer: Cigna of CA PPO |
$2,058.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,499.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,499.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,067.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,058.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,058.00
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,103.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,499.00
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$945.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$675.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.65
|
| Rate for Payer: United Healthcare All Other HMO |
$493.15
|
| Rate for Payer: United Healthcare HMO Rider |
$482.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.12
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,038.15
|
| Rate for Payer: Blue Shield of California Commercial |
$684.45
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$945.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,147.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$490.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$945.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$675.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.65
|
| Rate for Payer: United Healthcare All Other HMO |
$493.15
|
| Rate for Payer: United Healthcare HMO Rider |
$482.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$2,145.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$60.53 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,823.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,179.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,608.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cigna of CA HMO |
$1,394.25
|
| Rate for Payer: Cigna of CA PPO |
$1,587.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,823.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,823.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,823.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,501.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$858.00
|
| Rate for Payer: EPIC Health Plan Senior |
$858.00
|
| Rate for Payer: Galaxy Health WC |
$1,823.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,362.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,265.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,501.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,501.50
|
| Rate for Payer: Multiplan Commercial |
$1,716.00
|
| Rate for Payer: Networks By Design Commercial |
$1,394.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,823.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,287.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,287.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,823.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,823.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,823.25
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$2,145.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$1,823.25 |
| Rate for Payer: Adventist Health Commercial |
$429.00
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,501.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$858.00
|
| Rate for Payer: EPIC Health Plan Senior |
$858.00
|
| Rate for Payer: Galaxy Health WC |
$1,823.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,362.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,265.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.80
|
| Rate for Payer: Multiplan Commercial |
$1,716.00
|
| Rate for Payer: Networks By Design Commercial |
$1,394.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,823.25
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$926.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,176.57
|
| Rate for Payer: Blue Shield of California Commercial |
$775.71
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
IP
|
$5,246.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,049.20 |
| Max. Negotiated Rate |
$4,459.10 |
| Rate for Payer: Adventist Health Commercial |
$1,049.20
|
| Rate for Payer: Cash Price |
$2,360.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,672.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,098.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,098.40
|
| Rate for Payer: Galaxy Health WC |
$4,459.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,147.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,331.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,095.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.04
|
| Rate for Payer: Multiplan Commercial |
$4,196.80
|
| Rate for Payer: Networks By Design Commercial |
$3,409.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,459.10
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
OP
|
$5,246.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,049.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,049.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,459.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,885.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,934.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$2,360.70
|
| Rate for Payer: Cash Price |
$2,360.70
|
| Rate for Payer: Cigna of CA HMO |
$3,357.44
|
| Rate for Payer: Cigna of CA PPO |
$3,882.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,459.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,459.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,459.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,672.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,098.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,098.40
|
| Rate for Payer: Galaxy Health WC |
$4,459.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,147.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,331.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,095.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,672.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,672.20
|
| Rate for Payer: Multiplan Commercial |
$4,196.80
|
| Rate for Payer: Networks By Design Commercial |
$3,409.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,459.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,623.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,459.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,459.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,459.10
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
OP
|
$1,912.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$259.88 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$382.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,625.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,051.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,434.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna of CA HMO |
$1,242.80
|
| Rate for Payer: Cigna of CA PPO |
$1,414.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,625.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,625.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,625.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,338.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.80
|
| Rate for Payer: EPIC Health Plan Senior |
$764.80
|
| Rate for Payer: Galaxy Health WC |
$1,625.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,147.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,214.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,128.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,338.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,338.40
|
| Rate for Payer: Multiplan Commercial |
$1,529.60
|
| Rate for Payer: Networks By Design Commercial |
$1,242.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,625.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,147.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,147.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$956.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,625.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,625.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,625.20
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
IP
|
$1,912.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$382.40 |
| Max. Negotiated Rate |
$1,625.20 |
| Rate for Payer: Adventist Health Commercial |
$382.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,338.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.80
|
| Rate for Payer: EPIC Health Plan Senior |
$764.80
|
| Rate for Payer: Galaxy Health WC |
$1,625.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,147.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,214.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,128.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.88
|
| Rate for Payer: Multiplan Commercial |
$1,529.60
|
| Rate for Payer: Networks By Design Commercial |
$1,242.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,625.20
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cigna of CA HMO |
$247.68
|
| Rate for Payer: Cigna of CA PPO |
$286.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$328.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$328.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$270.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$270.90
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$328.95
|
| Rate for Payer: Vantage Medical Group Senior |
$328.95
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$328.95 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Blue Shield of California Commercial |
$196.21
|
| Rate for Payer: Blue Shield of California Commercial |
$297.60
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
|
|
HC ANKLE COMPLETE
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$671.50 |
| Rate for Payer: Adventist Health Commercial |
$158.00
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$553.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.00
|
| Rate for Payer: EPIC Health Plan Senior |
$316.00
|
| Rate for Payer: Galaxy Health WC |
$671.50
|
| Rate for Payer: Global Benefits Group Commercial |
$474.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$501.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$466.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.60
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: Networks By Design Commercial |
$513.50
|
| Rate for Payer: Prime Health Services Commercial |
$671.50
|
|
|
HC ANKLE COMPLETE
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$671.50 |
| Rate for Payer: Adventist Health Commercial |
$158.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.63
|
| Rate for Payer: Blue Shield of California Commercial |
$332.59
|
| Rate for Payer: Blue Shield of California Commercial |
$504.02
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna of CA HMO |
$505.60
|
| Rate for Payer: Cigna of CA PPO |
$584.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$553.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$671.50
|
| Rate for Payer: Global Benefits Group Commercial |
$474.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$501.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: Networks By Design Commercial |
$513.50
|
| Rate for Payer: Prime Health Services Commercial |
$671.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC ANKLE FOAM STIRRUP ADULT UVRSL
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
901698960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
HC ANKLE FOAM STIRRUP ADULT UVRSL
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
901698960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.63
|
| Rate for Payer: Blue Shield of California Commercial |
$41.57
|
| Rate for Payer: Blue Shield of California Commercial |
$63.06
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
IP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
905355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,722.52 |
| Max. Negotiated Rate |
$41,320.69 |
| Rate for Payer: Adventist Health Commercial |
$9,722.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,868.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,681.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,667.02
|
| Rate for Payer: Multiplan Commercial |
$38,890.06
|
| Rate for Payer: Networks By Design Commercial |
$31,598.18
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
IP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
915355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,722.52 |
| Max. Negotiated Rate |
$41,320.69 |
| Rate for Payer: Adventist Health Commercial |
$9,722.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,868.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,681.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,667.02
|
| Rate for Payer: Multiplan Commercial |
$38,890.06
|
| Rate for Payer: Networks By Design Commercial |
$31,598.18
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
OP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
905355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,667.02 |
| Max. Negotiated Rate |
$41,320.69 |
| Rate for Payer: Adventist Health Commercial |
$19,931.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,736.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,459.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,425.19
|
| Rate for Payer: Blue Shield of California Commercial |
$24,646.58
|
| Rate for Payer: Blue Shield of California Commercial |
$37,383.07
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,320.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,320.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,868.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,681.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,667.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,028.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,028.81
|
| Rate for Payer: Multiplan Commercial |
$38,890.06
|
| Rate for Payer: Networks By Design Commercial |
$24,306.29
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,167.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,167.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Senior |
$41,320.69
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
OP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
915355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,667.02 |
| Max. Negotiated Rate |
$41,320.69 |
| Rate for Payer: Adventist Health Commercial |
$19,931.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,736.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,459.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,425.19
|
| Rate for Payer: Blue Shield of California Commercial |
$24,646.58
|
| Rate for Payer: Blue Shield of California Commercial |
$37,383.07
|
| Rate for Payer: Cash Price |
$21,875.66
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,320.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,320.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,868.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,681.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,667.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,028.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,028.81
|
| Rate for Payer: Multiplan Commercial |
$38,890.06
|
| Rate for Payer: Networks By Design Commercial |
$24,306.29
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,167.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,167.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Senior |
$41,320.69
|
|
|
HC ANKLE LIMITED
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
909001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$398.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
