|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
OP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
905358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,476.24 |
| Max. Negotiated Rate |
$5,228.35 |
| Rate for Payer: Adventist Health Commercial |
$2,521.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,383.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,613.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,562.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4,539.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,989.39
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,228.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,228.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,689.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,305.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,305.70
|
| Rate for Payer: Multiplan Commercial |
$4,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,690.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,228.35
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
IP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
905358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,230.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,343.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.24
|
| Rate for Payer: Multiplan Commercial |
$4,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
IP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
915358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,230.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,230.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,343.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.24
|
| Rate for Payer: Multiplan Commercial |
$4,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
|
|
HC CUSTOM BREAST PROSTHESIS,LT WT
|
Facility
|
OP
|
$6,151.00
|
|
|
Service Code
|
CPT L8035
|
| Hospital Charge Code |
915358035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,476.24 |
| Max. Negotiated Rate |
$5,228.35 |
| Rate for Payer: Adventist Health Commercial |
$2,521.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,383.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,613.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,562.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4,539.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,989.39
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cash Price |
$3,383.05
|
| Rate for Payer: Cigna of CA HMO |
$4,305.70
|
| Rate for Payer: Cigna of CA PPO |
$4,305.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,228.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,228.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,460.40
|
| Rate for Payer: Galaxy Health WC |
$5,228.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,690.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,689.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,172.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,305.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,305.70
|
| Rate for Payer: Multiplan Commercial |
$4,920.80
|
| Rate for Payer: Networks By Design Commercial |
$3,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,228.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,690.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,246.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,014.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,228.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,228.35
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
IP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
905365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$813.40 |
| Max. Negotiated Rate |
$3,456.95 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$976.08
|
| Rate for Payer: Multiplan Commercial |
$3,253.60
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
IP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
915365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$813.40 |
| Max. Negotiated Rate |
$3,456.95 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$976.08
|
| Rate for Payer: Multiplan Commercial |
$3,253.60
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
OP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
915365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$239.28 |
| Max. Negotiated Rate |
$3,456.95 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,667.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,050.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,497.54
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Cigna of CA HMO |
$2,602.88
|
| Rate for Payer: Cigna of CA PPO |
$3,009.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,456.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,456.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$976.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,846.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.90
|
| Rate for Payer: Multiplan Commercial |
$3,253.60
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,440.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,440.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,033.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,033.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,033.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,033.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,456.95
|
|
|
HC CUSTOM MOLDED SHOES
|
Facility
|
OP
|
$4,067.00
|
|
|
Service Code
|
CPT A5501
|
| Hospital Charge Code |
905365501
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$239.28 |
| Max. Negotiated Rate |
$3,456.95 |
| Rate for Payer: Adventist Health Commercial |
$813.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,667.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,050.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,497.54
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Cash Price |
$2,236.85
|
| Rate for Payer: Cigna of CA HMO |
$2,602.88
|
| Rate for Payer: Cigna of CA PPO |
$3,009.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,456.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,456.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,626.80
|
| Rate for Payer: Galaxy Health WC |
$3,456.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,440.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,712.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,517.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$976.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,846.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.90
|
| Rate for Payer: Multiplan Commercial |
$3,253.60
|
| Rate for Payer: Networks By Design Commercial |
$2,643.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,456.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,440.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,440.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,033.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,033.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,033.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,033.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,456.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,456.95
|
|
|
HC CUSTOM SHOES, DEPTH INLAY(PR)
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
CPT L3230
|
| Hospital Charge Code |
905353230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Cigna of CA HMO |
$1,481.20
|
| Rate for Payer: Cigna of CA PPO |
$1,481.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$846.40
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,411.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$806.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,309.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.84
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: Networks By Design Commercial |
$1,058.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$794.13
|
| Rate for Payer: United Healthcare All Other HMO |
$772.97
|
| Rate for Payer: United Healthcare HMO Rider |
$756.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$692.99
|
|
|
HC CUSTOM SHOES, DEPTH INLAY(PR)
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT L3230
|
| Hospital Charge Code |
905353230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$287.31 |
| Max. Negotiated Rate |
$1,798.60 |
| Rate for Payer: Adventist Health Commercial |
$867.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,798.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,163.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,225.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,561.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,028.38
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Cigna of CA HMO |
$1,481.20
|
| Rate for Payer: Cigna of CA PPO |
$1,481.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,798.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,798.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,798.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$846.40
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,411.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,309.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,481.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,481.20
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: Networks By Design Commercial |
$1,058.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,269.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,269.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$794.13
|
| Rate for Payer: United Healthcare All Other HMO |
$772.97
|
| Rate for Payer: United Healthcare HMO Rider |
$756.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$692.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,798.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,798.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,798.60
|
|
|
HC CUTTING BALLOON
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,259.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,056.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,440.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,179.07
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cigna of CA HMO |
$1,228.80
|
| Rate for Payer: Cigna of CA PPO |
$1,420.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,632.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$768.00
|
| Rate for Payer: Galaxy Health WC |
$1,632.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,152.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,280.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,188.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,344.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: Networks By Design Commercial |
$1,248.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,632.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,152.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,152.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Other HMO |
$960.00
|
| Rate for Payer: United Healthcare HMO Rider |
$960.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$960.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,632.00
|
|
|
HC CUTTING BALLOON
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: EPIC Health Plan Senior |
$768.00
|
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.00
|
| Rate for Payer: Galaxy Health WC |
$1,632.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,152.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,280.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,188.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.80
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: Networks By Design Commercial |
$1,248.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,632.00
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.80 |
| Max. Negotiated Rate |
$866.15 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$668.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$560.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.77
|
| Rate for Payer: Cash Price |
$560.45
|
| Rate for Payer: Cigna of CA HMO |
$652.16
|
| Rate for Payer: Cigna of CA PPO |
$754.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$866.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$866.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$866.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: EPIC Health Plan Senior |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$630.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$713.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$713.30
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$611.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$611.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.50
|
| Rate for Payer: United Healthcare All Other HMO |
$509.50
|
| Rate for Payer: United Healthcare HMO Rider |
$509.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$866.15
|
| Rate for Payer: Vantage Medical Group Senior |
$866.15
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.80 |
| Max. Negotiated Rate |
$866.15 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Cash Price |
$560.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: EPIC Health Plan Senior |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$630.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.56
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
|
|
HC CVS SAMPLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC CVS SAMPLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,106.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.38
|
| Rate for Payer: Blue Shield of California EPN |
$71.60
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO |
$103.68
|
| Rate for Payer: Cigna of CA PPO |
$119.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,217.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,106.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1,106.36
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,814.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,106.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,394.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,482.52
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.00
|
| Rate for Payer: United Healthcare All Other HMO |
$81.00
|
| Rate for Payer: United Healthcare HMO Rider |
$81.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,106.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,106.36
|
|
|
HC CYCLIC CITRUL PEPT AB
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$125.08 |
| Rate for Payer: EPIC Health Plan Senior |
$12.95
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.08
|
| Rate for Payer: Blue Shield of California Commercial |
$51.51
|
| Rate for Payer: Blue Shield of California EPN |
$34.03
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC CYCLIC CITRUL PEPT AB
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC CYCLOSPORINE A (EMIT)
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
900910933
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$278.80 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$131.20
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
|
|
HC CYCLOSPORINE A (EMIT)
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
900910933
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$278.80 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.34
|
| Rate for Payer: Blue Shield of California Commercial |
$219.43
|
| Rate for Payer: Blue Shield of California EPN |
$144.98
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.05
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC CYLINDER CAST-THIGH TO ANKLE
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
950510041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$580.55 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Cash Price |
$375.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.92
|
| Rate for Payer: Multiplan Commercial |
$546.40
|
| Rate for Payer: Networks By Design Commercial |
$443.95
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
|
|
HC CYLINDER CAST-THIGH TO ANKLE
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
950510041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$375.65
|
| Rate for Payer: Cash Price |
$375.65
|
| Rate for Payer: Cash Price |
$375.65
|
| Rate for Payer: Cigna of CA HMO |
$437.12
|
| Rate for Payer: Cigna of CA PPO |
$505.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| Rate for Payer: Multiplan Commercial |
$546.40
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$443.95
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.50
|
| Rate for Payer: United Healthcare All Other HMO |
$341.50
|
| Rate for Payer: United Healthcare HMO Rider |
$341.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$341.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC CYSTOGRAM, INJECTION
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
909000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Senior |
$297.60
|
| Rate for Payer: Galaxy Health WC |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$460.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
|
|
HC CYSTOGRAM, INJECTION
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
909000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$487.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$455.33
|
| Rate for Payer: Blue Shield of California EPN |
$300.58
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna of CA HMO |
$476.16
|
| Rate for Payer: Cigna of CA PPO |
$550.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$632.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Senior |
$297.60
|
| Rate for Payer: Galaxy Health WC |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$460.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$520.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$520.80
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$446.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$446.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$372.00
|
| Rate for Payer: United Healthcare All Other HMO |
$372.00
|
| Rate for Payer: United Healthcare HMO Rider |
$372.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$372.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.40
|
| Rate for Payer: Vantage Medical Group Senior |
$632.40
|
|
|
HC CYSTOGRAPH MIN 3 VIEWS
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
909001901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$277.60 |
| Max. Negotiated Rate |
$1,179.80 |
| Rate for Payer: Adventist Health Commercial |
$277.60
|
| Rate for Payer: Cash Price |
$763.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$555.20
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$859.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.12
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: Networks By Design Commercial |
$902.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
|
