|
HC BONE/STEM TRANS ALLOG LYMPH
|
Facility
|
OP
|
$5,538.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
907702205
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$133.85 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,107.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$623.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,492.10
|
| Rate for Payer: Cash Price |
$2,492.10
|
| Rate for Payer: Cash Price |
$2,492.10
|
| Rate for Payer: Cigna of CA HMO |
$3,544.32
|
| Rate for Payer: Cigna of CA PPO |
$4,098.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,876.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| Rate for Payer: Galaxy Health WC |
$4,707.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,322.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,516.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,329.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| Rate for Payer: Multiplan Commercial |
$4,430.40
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$3,599.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,707.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,322.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,322.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
HC BONE/STEM TRANS ALLOG LYMPH
|
Facility
|
IP
|
$5,538.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
907702205
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,107.60 |
| Max. Negotiated Rate |
$4,707.30 |
| Rate for Payer: Adventist Health Commercial |
$1,107.60
|
| Rate for Payer: Cash Price |
$2,492.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,876.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,215.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,215.20
|
| Rate for Payer: Galaxy Health WC |
$4,707.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,322.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,516.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,267.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,329.12
|
| Rate for Payer: Multiplan Commercial |
$4,430.40
|
| Rate for Payer: Networks By Design Commercial |
$3,599.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,707.30
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
IP
|
$5,998.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,199.60 |
| Max. Negotiated Rate |
$5,098.30 |
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,399.20
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,439.52
|
| Rate for Payer: Multiplan Commercial |
$4,798.40
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
|
|
HC BONE/STEM TRANS AUTOLOGUS
|
Facility
|
OP
|
$5,998.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
907702202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$175.12 |
| Max. Negotiated Rate |
$11,924.00 |
| Rate for Payer: Adventist Health Commercial |
$1,199.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$815.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,924.00
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna of CA HMO |
$3,838.72
|
| Rate for Payer: Cigna of CA PPO |
$4,438.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| Rate for Payer: Galaxy Health WC |
$5,098.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,598.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,808.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,439.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| Rate for Payer: Multiplan Commercial |
$4,798.40
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$3,898.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,098.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,598.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
IP
|
$2,127.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$425.40 |
| Max. Negotiated Rate |
$1,807.95 |
| Rate for Payer: Adventist Health Commercial |
$425.40
|
| Rate for Payer: Cash Price |
$957.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.80
|
| Rate for Payer: EPIC Health Plan Senior |
$850.80
|
| Rate for Payer: Galaxy Health WC |
$1,807.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,276.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.48
|
| Rate for Payer: Multiplan Commercial |
$1,701.60
|
| Rate for Payer: Networks By Design Commercial |
$1,382.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.95
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
OP
|
$2,127.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.88 |
| Max. Negotiated Rate |
$1,807.95 |
| Rate for Payer: Adventist Health Commercial |
$425.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$545.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,357.03
|
| Rate for Payer: Blue Shield of California Commercial |
$895.47
|
| Rate for Payer: Cash Price |
$957.15
|
| Rate for Payer: Cash Price |
$957.15
|
| Rate for Payer: Cigna of CA HMO |
$1,361.28
|
| Rate for Payer: Cigna of CA PPO |
$1,573.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,807.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,276.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,701.60
|
| Rate for Payer: Networks By Design Commercial |
$1,382.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,276.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,276.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$479.08 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$479.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.96
|
| Rate for Payer: Blue Shield of California Commercial |
$133.88
|
| Rate for Payer: Blue Shield of California Commercial |
$202.88
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO |
$203.52
|
| Rate for Payer: Cigna of CA PPO |
$235.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
|
|
HC BONE WAX STERILE 2.5G
|
Facility
|
OP
|
$32.96
|
|
| Hospital Charge Code |
901698818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Adventist Health Commercial |
$6.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.15
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$21.09
|
| Rate for Payer: Cigna of CA PPO |
$24.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$28.02
|
| Rate for Payer: Global Benefits Group Commercial |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.07
|
| Rate for Payer: Multiplan Commercial |
$26.37
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.48
|
| Rate for Payer: United Healthcare All Other HMO |
$16.48
|
| Rate for Payer: United Healthcare HMO Rider |
$16.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$28.02
|
|
|
HC BONE WAX STERILE 2.5G
|
Facility
|
IP
|
$32.96
|
|
| Hospital Charge Code |
901698818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Adventist Health Commercial |
$6.59
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$28.02
|
| Rate for Payer: Global Benefits Group Commercial |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.91
|
| Rate for Payer: Multiplan Commercial |
$26.37
|
| Rate for Payer: Networks By Design Commercial |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$28.02
|
|
|
HC BOOT CAST PEDS LG
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.79
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.59
|
| Rate for Payer: Cigna of CA PPO |
$85.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.49
|
| Rate for Payer: United Healthcare All Other HMO |
$57.49
|
| Rate for Payer: United Healthcare HMO Rider |
$57.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.74
|
| Rate for Payer: Vantage Medical Group Senior |
$97.74
|
|
|
HC BOOT CAST PEDS LG
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692802
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
|
|
HC BOOT CAST PEDS MED
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692801
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.79
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.59
|
| Rate for Payer: Cigna of CA PPO |
$85.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.49
|
| Rate for Payer: United Healthcare All Other HMO |
$57.49
|
| Rate for Payer: United Healthcare HMO Rider |
$57.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.74
|
| Rate for Payer: Vantage Medical Group Senior |
$97.74
|
|
|
HC BOOT CAST PEDS MED
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692801
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
IP
|
$114.99
|
|
| Hospital Charge Code |
901692800
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
|
|
HC BOOT CAST PEDS SM
|
Facility
|
OP
|
$114.99
|
|
| Hospital Charge Code |
901692800
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.74 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.79
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.59
|
| Rate for Payer: Cigna of CA PPO |
$85.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.74
|
| Rate for Payer: Global Benefits Group Commercial |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.49
|
| Rate for Payer: Multiplan Commercial |
$91.99
|
| Rate for Payer: Networks By Design Commercial |
$74.74
|
| Rate for Payer: Prime Health Services Commercial |
$97.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.49
|
| Rate for Payer: United Healthcare All Other HMO |
$57.49
|
| Rate for Payer: United Healthcare HMO Rider |
$57.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.74
|
| Rate for Payer: Vantage Medical Group Senior |
$97.74
|
|
|
HC BOOT MULTIPODUS CHILD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604776
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC BOOT MULTIPODUS CHILD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604776
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.07
|
| Rate for Payer: Blue Shield of California Commercial |
$446.02
|
| Rate for Payer: Blue Shield of California Commercial |
$294.06
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BOOT MULTIPODUS SMALL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT MULTIPODUS SMALL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| 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 |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$175.00
|
| 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 |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| 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 BOOT MULTIPODUS TODDLER
|
Facility
|
OP
|
$550.94
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604929
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.23 |
| Max. Negotiated Rate |
$468.30 |
| Rate for Payer: Adventist Health Commercial |
$225.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.48
|
| Rate for Payer: Blue Shield of California Commercial |
$423.67
|
| Rate for Payer: Blue Shield of California Commercial |
$279.33
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cigna of CA HMO |
$385.66
|
| Rate for Payer: Cigna of CA PPO |
$385.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.38
|
| Rate for Payer: EPIC Health Plan Senior |
$220.38
|
| Rate for Payer: Galaxy Health WC |
$468.30
|
| Rate for Payer: Global Benefits Group Commercial |
$330.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.66
|
| Rate for Payer: Multiplan Commercial |
$440.75
|
| Rate for Payer: Networks By Design Commercial |
$275.47
|
| Rate for Payer: Prime Health Services Commercial |
$468.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.77
|
| Rate for Payer: United Healthcare All Other HMO |
$201.26
|
| Rate for Payer: United Healthcare HMO Rider |
$196.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.30
|
| Rate for Payer: Vantage Medical Group Senior |
$468.30
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901606206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
IP
|
$550.94
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604929
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$110.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cash Price |
$247.92
|
| Rate for Payer: Cigna of CA HMO |
$385.66
|
| Rate for Payer: Cigna of CA PPO |
$385.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.38
|
| Rate for Payer: EPIC Health Plan Senior |
$220.38
|
| Rate for Payer: Galaxy Health WC |
$468.30
|
| Rate for Payer: Global Benefits Group Commercial |
$330.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.23
|
| Rate for Payer: Multiplan Commercial |
$440.75
|
| Rate for Payer: Networks By Design Commercial |
$358.11
|
| Rate for Payer: Prime Health Services Commercial |
$468.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.77
|
| Rate for Payer: United Healthcare All Other HMO |
$201.26
|
| Rate for Payer: United Healthcare HMO Rider |
$196.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.43
|
|
|
HC BOOT MULTIPODUS TODDLER
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901606206
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| 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 |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$175.00
|
| 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 |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| 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 BOOT MULTIPODUS YOUTH
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L4396
|
| Hospital Charge Code |
901604928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
