|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906820031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$525.30 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.32
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906820031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna of CA HMO |
$401.70
|
| Rate for Payer: Cigna of CA PPO |
$457.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO |
$413.40
|
| Rate for Payer: Cigna of CA PPO |
$470.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC DLTR VESSEL 5FR
|
Facility
|
OP
|
$50.84
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$43.21 |
| Rate for Payer: Adventist Health Commercial |
$10.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.22
|
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: Cigna of CA HMO |
$32.54
|
| Rate for Payer: Cigna of CA PPO |
$37.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.34
|
| Rate for Payer: Galaxy Health WC |
$43.21
|
| Rate for Payer: Global Benefits Group Commercial |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.59
|
| Rate for Payer: Multiplan Commercial |
$40.67
|
| Rate for Payer: Networks By Design Commercial |
$33.05
|
| Rate for Payer: Prime Health Services Commercial |
$43.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.42
|
| Rate for Payer: United Healthcare All Other HMO |
$25.42
|
| Rate for Payer: United Healthcare HMO Rider |
$25.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.21
|
| Rate for Payer: Vantage Medical Group Senior |
$43.21
|
|
|
HC DLTR VESSEL 5FR
|
Facility
|
IP
|
$50.84
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$43.21 |
| Rate for Payer: Adventist Health Commercial |
$10.17
|
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.34
|
| Rate for Payer: Galaxy Health WC |
$43.21
|
| Rate for Payer: Global Benefits Group Commercial |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$40.67
|
| Rate for Payer: Networks By Design Commercial |
$33.05
|
| Rate for Payer: Prime Health Services Commercial |
$43.21
|
|
|
HC DLTR VESSEL 6FR
|
Facility
|
OP
|
$53.79
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$45.72 |
| Rate for Payer: Adventist Health Commercial |
$10.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.03
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Cigna of CA HMO |
$34.43
|
| Rate for Payer: Cigna of CA PPO |
$39.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.52
|
| Rate for Payer: EPIC Health Plan Senior |
$21.52
|
| Rate for Payer: Galaxy Health WC |
$45.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.65
|
| Rate for Payer: Multiplan Commercial |
$43.03
|
| Rate for Payer: Networks By Design Commercial |
$34.96
|
| Rate for Payer: Prime Health Services Commercial |
$45.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.89
|
| Rate for Payer: United Healthcare All Other HMO |
$26.89
|
| Rate for Payer: United Healthcare HMO Rider |
$26.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.72
|
| Rate for Payer: Vantage Medical Group Senior |
$45.72
|
|
|
HC DLTR VESSEL 6FR
|
Facility
|
IP
|
$53.79
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$45.72 |
| Rate for Payer: Adventist Health Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.52
|
| Rate for Payer: EPIC Health Plan Senior |
$21.52
|
| Rate for Payer: Galaxy Health WC |
$45.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.91
|
| Rate for Payer: Multiplan Commercial |
$43.03
|
| Rate for Payer: Networks By Design Commercial |
$34.96
|
| Rate for Payer: Prime Health Services Commercial |
$45.72
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
IP
|
$53.30
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Multiplan Commercial |
$42.64
|
| Rate for Payer: Networks By Design Commercial |
$34.65
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
OP
|
$53.30
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.73
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cigna of CA HMO |
$34.11
|
| Rate for Payer: Cigna of CA PPO |
$39.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.31
|
| Rate for Payer: Multiplan Commercial |
$42.64
|
| Rate for Payer: Networks By Design Commercial |
$34.65
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.65
|
| Rate for Payer: United Healthcare All Other HMO |
$26.65
|
| Rate for Payer: United Healthcare HMO Rider |
$26.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.30
|
| Rate for Payer: Vantage Medical Group Senior |
$45.30
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
905365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,463.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,370.67
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,897.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,897.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,381.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,562.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,562.40
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,339.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
915365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,381.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
905365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,381.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
915365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,463.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,370.67
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,897.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,897.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,381.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,562.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,562.40
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,339.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,897.20
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$132.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.36
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$135.72 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.72
|
| Rate for Payer: Blue Shield of California Commercial |
$24.08
|
| Rate for Payer: Blue Shield of California EPN |
$15.91
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.55
|
| Rate for Payer: EPIC Health Plan Senior |
$13.74
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.13
|
| Rate for Payer: United Healthcare HMO Rider |
$11.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
HC DOPPLER
|
Facility
|
OP
|
$2,447.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$2,079.95 |
| Rate for Payer: Adventist Health Commercial |
$489.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,604.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,502.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,497.56
|
| Rate for Payer: Blue Shield of California EPN |
$988.59
|
| Rate for Payer: Cash Price |
$1,101.15
|
| Rate for Payer: Cash Price |
$1,101.15
|
| Rate for Payer: Cash Price |
$1,101.15
|
| Rate for Payer: Cigna of CA HMO |
$1,566.08
|
| Rate for Payer: Cigna of CA PPO |
$1,810.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$2,079.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,468.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$315.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,632.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,957.60
|
| Rate for Payer: Networks By Design Commercial |
$1,590.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,079.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,468.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,468.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DOPPLER
|
Facility
|
IP
|
$2,447.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$489.40 |
| Max. Negotiated Rate |
$2,079.95 |
| Rate for Payer: Adventist Health Commercial |
$489.40
|
| Rate for Payer: Cash Price |
$1,101.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.80
|
| Rate for Payer: EPIC Health Plan Senior |
$978.80
|
| Rate for Payer: Galaxy Health WC |
$2,079.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,468.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,632.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$932.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,514.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.28
|
| Rate for Payer: Multiplan Commercial |
$1,957.60
|
| Rate for Payer: Networks By Design Commercial |
$1,590.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,079.95
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
905352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$135.00
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.33
|
| Rate for Payer: United Healthcare All Other HMO |
$98.63
|
| Rate for Payer: United Healthcare HMO Rider |
$96.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.42
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
905352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.38
|
| Rate for Payer: Blue Shield of California Commercial |
$199.26
|
| Rate for Payer: Blue Shield of California EPN |
$131.22
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$135.00
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.33
|
| Rate for Payer: United Healthcare All Other HMO |
$98.63
|
| Rate for Payer: United Healthcare HMO Rider |
$96.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
915352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$135.00
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.33
|
| Rate for Payer: United Healthcare All Other HMO |
$98.63
|
| Rate for Payer: United Healthcare HMO Rider |
$96.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.42
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
915352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.38
|
| Rate for Payer: Blue Shield of California Commercial |
$199.26
|
| Rate for Payer: Blue Shield of California EPN |
$131.22
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$135.00
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.33
|
| Rate for Payer: United Healthcare All Other HMO |
$98.63
|
| Rate for Payer: United Healthcare HMO Rider |
$96.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
915352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.92 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.26
|
| Rate for Payer: Blue Shield of California Commercial |
$295.94
|
| Rate for Payer: Blue Shield of California EPN |
$194.89
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
915352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
905352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.92 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.26
|
| Rate for Payer: Blue Shield of California Commercial |
$295.94
|
| Rate for Payer: Blue Shield of California EPN |
$194.89
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
905352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
